SECOND GENERATION SOI ADVENTURES

just in case you didn't remember, i'll remind you that you're asian

2010-04-26T08:22:00.004-04:00

ugh, so i fell off the wagon again re: blogging, which is really depressing since 2/3 of my intern year is over. i meant to document my intern year , or at least use my blog as a means to process the pretty significant changes that have gone on this year, but i think i've always felt that i've needed to have some sort of beginning, middle, and end to every entry and the challenge sometimes (or often) seems too insurmountable. my good friend liz eaman has made it a point to do at least one entry per month throughout her residency, and i think that's something i'm going to try to do from now on.

so, not even sure where to begin here. i thought about writing because of an interaction i had this morning with an older man (mediterranean maybe?) in a coffeehouse. at first, he was friendly, talking to me about michigan (as i was wearing a michigan sweatshirt) and how he used to live in detroit. soon, he started talking about how "you people came and started selling your toyotas, hondas, and all those cars and then americans couldn't sell cars anymore." i wasn't sure exactly how to respond as i didn't want to start a confrontation (and this guy definitely seemed like he could be really confrontational). he asked if i was korean, japanese, or chinese. i was like, "i'm thai, from thailand." he briefly talked about how he had served in vietnam (had he? i don't know, he seemed a little old to have, but who knows) and how vietnamese and communists were "invisible" and "hard to see." to clarify, he told me i was "american" as he could tell that i was "born here." as he was leaving, he told me, "baby doll, i wish you the best." it was really awkward, and the barista apologized to me afterwards for his conduct, saying he had recently tried to start a fight with another customer earlier, but people knew he wasn't totally right. i was like, oh, it's ok, but it got me thinking about other experiences i've had this year where people have made comments (direct or otherwise) about my race/ethnicity.

one, white patient from rural west VA who stated that she "couldn't understand me from the way i looked" and refused to let me go through her discharge instructions ( i did, anyway) but said she wouldn't leave until she "saw a white doctor." the white doctor never came, and she ended up leaving anyway. my attending (supervising physician) was really supportive, so that was good, but i always feel like you can't say anything to patients since you have to be the one being "professional" and you're not there to challenge their sometimes terrible beliefs about race, politics, whatever, but are there for their health.

two, on my last month in the medical intensive care unit (MICU), i went to do 'morning' rounds on some of my patients (this is around 4 or 5 am) and came out to the nursing area to look at some patient charts. the nurses were discussing my name, how it's ridiculous and how they always laugh when they read it, etc, etc. they didn't see me as i was on the periphery. i got the information i needed from the patient chart and walked away. i half mentioned the incident to another colleague, and they were like, oh, that sucks, MICU night nurses can be so annoying. i was like yeah, and then that was it.

in that incident, i felt bad because i didn't say anything, which is so unlike me and my character. i couldn't even say which nurses were talking about me at this point. i just know i felt crappy about it, but talking with other interns about our whole experience (which does a lot of ups, i can say, not just these downs), one person described it as "being an injured dog and getting kicked while you're down."

why didn't i say anything? i had been up for close to 24 hrs at that point and had another six or seven to go, i was tired, i didn't want to get into a fight, i didn't want the nurses that i depend on and need to work with for the next two years to resent me or try to "get back" at me, i feel like interns are really at the bottom of hospital totem pole hierarchy, it is exhausting.

i know, you've always got to pick and choose your battles. i guess i have been in battles regarding patient care, but i haven't been in too many battles for myself (at the hospital, anyway). although this has been generally okay and i feel like i have pretty good self-efficacy and confidence and all that, it has been a pretty decent beat-down by the system.

next time, i think i'm going to try to say something.

friends and family

2009-10-27T22:21:00.003-04:00

to take a break from writing about work life, i'm recounting some moments where i've felt like a normal person over the past few months, which generally involves connecting with friends and family on my precious days off. although im on vacation now with chris in bangkok (yay!), i normally get one day off every 7-8 days while im on the wards or in the icu. im often tempted to sleep the whole day, but then would waste an entire day off and miss spending time with chris, so lately i've been more proactive about seeing people and doing things. this has been helped by the fact that a lot of friends and family have visited over the past few months, including:

rollie and meena from michigan! our first real houseguests, they cooked us amazing vegetarian meals like dutch babies (pancakes, not people) and enchiladas. in turn, we took them to the inner harbor where both me and meena got food poisoning from phillip's seafood. crab mac and cheese sounded like a great idea to begin with, but didn't turn out so well in the end...

meeting up with judy, a fellow swattie classmate in dc, who invited us to a "crafty bastards", a local diy craft fair which also showcased a breakdancing competition. one of our fave booths at this fair was mean cards ,a collection of hilarious cards for all different occasions. judy regaled us with stories from her days of intensive russian language learning at USAID, while i ate ice cream and drank coffee and whined about intern life.

sleepover with sae-rom, a fellow AMSA GHAC'er who's spending a year at Hopkins School of Public Health and is never in town, ever.

catching up with liz and andrea in dc, who came out for the annual GLMA conference. we mostly just hung out in dupont circle near the fountain, but it was great to catch up with some michigan peeps. i've also run into former classmates at bayview, including having a late night coffee with carl miller while he was on nights in the radiology reading room, and catching a short conversation with christina weng, who kindly came to do an ophthamology consult while i was in the CCU.

going to the sauna in columbia as rachel, a co-intern's guest. chatting and drinking ice cold water out of bell jars that rachel provided.

eating a post-call early dinner with mary (friend from high school) and her boyfriend tom, before they ran off to virginia for a peace corps friend wedding.

hanging out with matt alemu, a ford school classmate, who kindly drove out to visit us to play wii with chris :) .

having my family over and taking them out to eat chinese food, thai food, italian food...yoda remembering them and being super excited! (they came to pick him up to dogsit him while chris and i are on vacation in bangkok).

snapshots of intern life

2009-10-27T20:35:00.005-04:00

i was really good about writing for awhile, but then fell off the wagon when i started my first month on the wards (general medicine inpatient service) and then went straight from there to the cardiac icu. i've taken care of a lot of patients during that time, and had some real ups and downs, but i've also realized that i'm becoming a lot more competent and don't totally panic whenever i get a page in the middle of the night, which is a real improvement.

i've also gotten more used to my schedule, and realized it was a sad day (or perhaps a happy one?) when I got out of work after being there for 12 hrs and was rejoicing because I was going home early. mind you, the only reason i realized this was because i called chris and he was like, "um, i thought early was like 4 pm or something, not 6:30." grrr chris and his normal job! at the beginning of intern year, i did harbor some resentment against chris for working a third of the hours and getting paid disproportionately more money, but i am pretty over it and am thankful that he's able to entertain himself on my call days by doing various home improvement projects, like painting and installing recessed lighting. i also really appreciate that he drives me to work on call days and picks me up post-call so i don't have to drive after being up for over 30 hrs!

speaking of being up for over 30 hrs, i feel like call is when i really get to bond with a lot of people, including not only my fellow interns and residents, but also nursing and other ancillary staff, and finally, with patients. while on the wards, we take call every 4th night, which means that as an intern, we'll admit five patients to our service over the day and serve as the primary physician for that patient until they're either discharged from the hospital or transferred to another service.

because so many of our patients either don't have insurance or are really underinsured, their health care can often be really fragmented. as an inpatient, case managers, social workers, and medical staff attempt to bring about a smooth transition to outpatient care, but things don't always work out. this can be because a patient doesn't show up for follow-up, but that can be for so many reasons, like they didn't have a ride, or didn't have the money for co-pay or whatever. i've also been impressed by a serious lack of primary care among our patients, and tried to use the connections i make with patients to establish primary care relationships with them when possible.

one patient that i really hope to see in clinic soon had a pretty terrible infection that started in a joint and spread to the blood. patient X also had a bunch of other complications from the original infection, which required long-term intravenous antibiotics. a lot of times people can get a PICC line placed and go home and get their IV antibiotics, but if you have a history of drug abuse, that's usually a no-go. this is interesting to me, because if you don't have a urine toxicology screen that's positive, the only way you would have this kind of information is if the patient discloses to you or you have some old records documenting this (or you can just be suspicious, given their own history if there's complications related to drug use). in any case, if you are an IV drug user, you don't get home IV antibiotics because there's a fear (likely well-founded) that you'll inject illicit drugs into your central line (which goes straight to your heart). this also means that in order to get IV antibiotics, you have to go stay in a nursing facility instead of going home for up to months at a time, depending on the length of course of your particular antibiotics.

this particular patient totally denied past IV drug use, but later admitted to it when a complication happened that's more often than not seen in drug users, although it probably wasn't related in this person's case. because she had so many complications, she ended up being re-admitted to the hospital a few times during my month ont he wards and i got to spend some time with her, sharing her frustrations at failed treatments, or setbacks in the road to recovery. when we finally got to discharge her home, she asked if it was ok to give me a hug and thanked me for not just taking care of her, but also really caring about her, which was totally great.

ive had lots of little moments like this throughout residency so far. sitting with an italian immigrant patient an talking about where our families are from and who makes up our family now and listening to him talk about how he used to go dancing in the city. taking a break from writing history and physicals with a co-intern to watch music videos together on youtube 20 hrs in to a 30+ hr shift. holding a patient's hand when he requested to be taken off oxygen so that he could die peacefully and with dignity, without noise, without machines. saying goodbye to another patient who had been through so much in his fifty years of life, and feeling sorry that i'd never gotten to buy him the fried chicken that he'd asked for, feeling even sorrier that he couldn't eat in the last two weeks of his life. a unit secretary feeling sorry for me as i fell asleep at a computer and bringing me a fresh cup of coffee that she'd fixed at 4 am. feeling proud of myself when i got an arterial line on my first stick, feeling bad about myself when i couldn't thread a central line, and a little less bad when the resident couldn't do it either. seeing people suffer and recover, and really respecting the strength of a lot of people in times of great distress.

i think that's what i've most appreciated about my intern year so far -connecting with people.

death and the icu

2009-08-24T16:45:00.006-04:00

so, i haven't written in awhile, and im coming up on my last of eight calls this month in the ICU (intensive care unit). there are two icu's we rotate in as interns, the cardiac icu (CCU) and medical icu (MICU); this month i've done two weeks in each unit.

as my first inpatient month, the cardiac icu was a bit of a shocker. the first week, i worked 95 hrs and was a bit overwhelmed by the experience even if i wasn't super busy admitting patients. like learning a foreign language, it took a bit to get used to the EMR (electronic medical record) and ordering system they have at bayview, and figure out who to talk to to get things done. i have a better grasp of how the whole hospital works after a month, but im sure i still have a lot to learn.

i actually have really been enjoying critical care. one of my friends laughed when i told him this, and said "yah, the patients don't talk!" that's part of it, maybe, but i really like patients most of the time, and often, patients' families, some of who can talk A LOT.

part of being in the hospital so much as an intern makes me feel disconnected from what's going on in the outside world. even though i try to read some news websites while im at work, i am pretty much clueless about what's going on, including at first, all the talk about "death panels" in the media. i mean, it's pretty sad when i learn about death panels from someecards.com or rely on youtube clips like bernie frank's diss of this woman who compared obama health care reform to nazi germany to see how misinformed so many people are about what is actually going on. that's not necessarily the point of this blog though, so i'll stop here, and share some patient stories with you.

from the cardiac icu:

an elderly man was admitted to the cardiac ICU with a heart attack. our attending was excited because it might be a manifestation of stress cardiomyopathy, which can happen when people experience some kind of huge stress, whether it be a crazy surprise party or a death of a loved one. it ended up not being that, but i talked to him a lot anyway one morning when i went to check on him before rounds. his wife had passed away at home hospice a few weeks prior to his heart attack, and he was still in grief. he talked about how they had been married for almost sixty years, how she had made him happy, and how he hoped he had done the same for her. he also shared how proud he was of his daughter, who had taken both him and his wife in when he couldn't take care of his wife's needs as much anymore, and how they had all been there together when she passed away. then, he joked that nobody really wanted to listen to the ramblings of an old man anyway, and i replied that i did, if he wanted to talk. he decided that he wanted to rest, but thanked me for listening. he was later discharged from the hospital in pretty good condition, and i was really impressed with his daughter who was managing to keep it all together while her parents were nearing the end of their lives. i hope she gets to hear from him how proud he is, because she was a real patient advocate for her father, refusing tests that wouldn't change management and that would also make him uncomfortable. they had decided together that he did not want to be resuscitated or intubated (have a tube put down his throat and be connected to a ventilator) and i really think this is such an important discussion to have while you still have your wits about you and you can communicate what you'd like to happen with someone close to you.

on the flip side, from the medical icu:

a middle-aged man was admitted to the medical icu after being found down at a nursing home. it was difficult to piece together what exactly happened, but our best guess is that he had an episode of low blood sugar, causing him to go into seizures and eventually asystole (flat-lining). he was successfully resuscitated but never responsive. he ended up having continuous seizures for days before high doses of multiple anti-seizure medications could control them; his mri showed multiple infarcts (aka dead matter). he had no family, so a friend was located who eventually agreed to act as his medical decision-maker (aka surrogate). it's definitely a tough situation to be in, and we have not withdrawn care yet, even though the prognosis is really poor and he's being kept alive by machines.

and finally, i did experience my first death during a code, or resuscitation, in the unit. i didn't know a lot about the patient, but he was supposedly very functional, living and taking care of his wife with dementia, and his death was really sudden and a big shock to his family. he came in in a really bad way, and we all thought he was going to die, but then suddenly the curtain to the room was being pulled and the crash cart was being pulled in and the code was going, an X-ray was done and it came up with the lungs in complete white-out, blood was pouring out of the endotracheal tube, and it was over.

i've had patients die before, but for some reason, this time felt different, even if i wasn't his primary caretaker, and just participated a little bit in his care before he passed. we talked about dealing with death at one noon conference earlier this year and what stuck in my mind from that time was how often you just erase the patient's name from the board where you keep the census and then fill out the death certificate and forms and then that's it. that's kinda what happened in this situation; i followed my resident who told the family that their loved one had passed, there was crying, and then a short visitation with the body after he had been cleaned up by the nurses. then his name was erased from the board, and we went on doing our other work, rounding on patients, putting in orders, admitting new patients to the unit. later on in the night, we were discussing the case with another resident who came to visit, and i almost couldn't even remember his name when we were trying to find the X-rays to show him. i felt terrible about it for a second, but then i reminded myself that i only knew him for less than an hour, and what i did know about him wasn't anything at all about his life, but just his death. this was sad to me, but that's what sometimes happens in the unit, and i hope he is resting in peace.

my secret life as a psychiatrist

2009-07-16T19:46:00.004-04:00

so, im on this rotation named 'med-psych'. i actually thought about doing med-psych combined residency and was thinking this month might be like that, but the name med-psych is somewhat of a misnomer. the month is more a combo of physical diagnosis rounds, lectures, simulated patients, reflecting on experiences, clinic, and some psych here and there.

psych was actually one of my most fave rotations in med school, so im happy to be doing some psych this month and learning about how the psych department interfaces with medicine as a consult service and what services are available both on the inpatient and outpatient side of things.

i was basically just oriented on my first day on psych consults, saw a patient with the attending, and then listened to social workers in the ER talk to the attending about cases. the next time i was back on consults, the attending was swamped, and asked if i wanted to see a patient on my own. of course, i said yes! it was my chance to be a true med-psych person for one day.

the consult was to evaluate a woman who had some chronic chest pain for anxiety. i fumbled through my disorganized papers and kicked myself for not having on hand the lecture notes on anxiety disorders that this same attending had given me a few days before. i was paying attention during the lecture, i swear, but it still helps to ground myself before i go to see the patient. in any case, i read some stuff quickly online, looked over the patient record, and then went off to see the patient.

when i entered the room, the nurse was giving some medication, so i just said "Hi" and waited for him to finish. the first thing the patient said to me was, "Hi! You're really beautiful." internally, i was like uh-oh, this could be trouble. after saying thanks for the compliment and asking how she was doing, i introduced myself as an intern with the psychiatry team. the patient totally flipped and yelled at me to get out, saying she did not want to see a psychiatrist, did not need to see a psychiatrist, and didn't want anything to do with psychiatry. i tried to clarify that i was not an actual psychiatrist (but was working with the psych consult team) and just wanted to ask her a few questions. the nurse had my back (yay!) and was like, 'why don't you just listen to what she has to say before you tell her to leave?' unfortunately, this was to no avail, and she kept yelling at me, saying she was going to sue the hospital, asking who had sent me, etc. i switched tactics and asked her if she'd had a bad experience with psych before, but she wouldn't respond. eventually, i ended up leaving, and the nurse was like, "well, you can't help people who don't want to be helped."

i was dejected as i headed back to one of the doctor work rooms to page the psych attending. i felt like i had failed without even trying, and wasn't helping out because i wasn't able to complete the consult. when i talked to the attending on the phone, she apologized for putting me in that situation and said that i'd done what i could do. patients who are competent have a right to refuse psych consults (or any other procedure) but i still felt like there was unfinished work to be done on her - i hope the primary team was able to sort things out.

after my unsuccessful attempt to see a patient alone, i accompanied the attending to see a pleasant man who was totally manic after he had been taken off his psych meds during a medical hospitalization. he was seriously talking a mile a minute, not making a ton of sense, and constantly on the move. the psych attending miraculously was able to get him to sign a voluntary commitment form for him to be transferred over to the psych ward after spending about 10 minutes with him, redirecting him at times, and just trying to listen to what he had to say (which was a lot). i hope he gets back on meds that help him get back to his baseline and he can go back to living in his pseudo-assisted living facility for people with chronic mental illness.

despite not having gone into psych , im happy i had a chance to do some psych consults this month and attend some psych lectures, which i've really enjoyed, except for an off-topic comment by one of the lecturers about how he didn't believe that accepting pens or other paraphernalia from pharmaceutical companies was a conflict of interest. "As if we were so easily swayed," he muttered. it was the end of the lecture and i didn't want to drag it into lunchtime, but under my breath i was like, "We totally are! And there's tons of EVIDENCE to prove that marketing makes a DIFFERENCE in physician prescribing patterns." and then i remembered from amsa days that the APA has a really terrible record of accepting all kinds of $$ from pharma and that ive rarely seen a pharm-free psychiatrist. oh well - have to choose your battles, right?

in conclusion, even though my med-psych month is ending, im sure ill have *tons* of psych issues to deal with in my own clinic (ive already had two patients with bipolar disorder) and also on the wards. more to come! :)

strong work: night float, part 2

2009-07-09T16:19:00.002-04:00

so, i don't anticipate describing every patient i ever see in residency on the blog, but i did want to talk briefly about my second night as night float, when i served as the admitting intern.

i admitted one patient overnight on my first night float night, which was a good way to start - it was also slow, so i definitely would've done more if there were more patients admitted to medicine. at the outset, it seemed to be a pretty straightfoward case - young woman, nausea, vomiting, abdominal pain for a couple days, CT scan showed signs concerning for pancreatitis. the basic treatment for pancreatitis is really straightforward - nothing by mouth, lots of IV fluids, pain control. great way to start out, learn basic ordering in the computer system.

i went to talk to the patient and her boyfriend and learned about what had been going on - it seemed like the pain had been going on a lot longer, and i got some other information, but the working diagnosis was still pancreatitis. she seemed really anxious, didn't have insurance, and didn't really want to stay. i tried to 'talk her down', let her know what the plan was, and told her i would check in as the night went on. looking at her bloodwork over time; however, i noticed that her blood count was dropping. this could be due to a dilutional effect, where the IV fluids you get 'dilutes' your blood count so it appears that there are less red blood cells than there really are. her blood count kept dropping over time though, so i told the resident i was concerned that there might be more going on even though the patient "looked" great. he agreed that the blood count was low, and it was still low even after we repeated the blood draw, so we decided to get another CT scan, just in case she was bleeding.

as predicted, when i called the radiology resident to ask if she could read the CT, she questioned why we would order another CT eight hours after the patient had just gotten one. i told her that the blood count had dropped considerably and we were concerned about bleeding. she said she didn't see anything, and then i was like, ok, well, better safe than sorry.

as i was getting ready to catch a few winks of sleep, the radiology resident called me back and said on further review, there was hemorrhage in the cul-de-sac, but she couldn't identify the source of the bleeding. i called the general surgery team to evaluate her right away and they said they would see her. after a couple hours, i called them back to see if they had any recommendations and they determined that the likely source of the bleed was a ruptured ovarian cyst. i felt happy because this was on my differential (a list of possible diagnoses you think of at the outset), and then called gynecology to come take a look at the patient before handing her off to the day team who would assume her primary care.

there was more to the story than just this, like keeping the patient informed about developments, trying to enforce rules about family (or boyfriends) staying in the room overnight but letting the patient know that i was still on her side, and making sure everyone was on the same page. when i left in the morning, i was proud that i'd been part of "catching" something that could have been easily overlooked, and also happy that the resident i'd worked with had given me one of the best compliments that a doctor-in-training can get - "strong work!"

patients and patience

2009-07-08T21:12:00.005-04:00

so, as many of you know, i 'officially' started residency at johns hopkins bayview on july 1, 2009, which is the official start date for residencies throughout the us. in reality, most of us start before, and we had three days of orientation before starting our first rotation on june 25th.

i started on one of the "easy" months of intern year named "Med-Psych". med-psych is basically a smorgasbord of physical diagnosis rounds, where we go see patients with interesting findings and work on honing physical exam skills, attend different clinics (derm, psych consults, and our clinic where we follow patients over 3 years) and lectures, work on physician-patient communication skills, and do touchy-feely activities talking about our experiences, which i generally like. we also do one weekend of night float.

so, as a doctor, i have my 'own' patients, patients that i serve as the primary care provider for. i saw my first patient in my first clinic on my first day of residency. after a whirlwind orientation by our trusty senior resident attending, i grabbed the chart and walked in. the patient was new to the practice, so there were no old records to look at - just starting off afresh.

even though my first patient was there for a physical, he also was establishing care for the first time in awhile and i spent most of the time just talking to him. he was older, around my parents' age, and he reminded me of a trucker, in a lonely type of way. he had some pretty wicked tattoos, and i asked about them - many of them were related to martial arts, and we ended up spending some time talking about that, and buddhism, and meditation. after we had gone through all the required questions and physical exam and i finally (half) figured out how to complete all the paperwork for a new patient, he said,

"thank you so much for listening to me! i can tell you really care - that's why you went and got that MD after your name. i'm really glad you're my doctor."

i was kinda speechless, and was just like, "thank you. im glad youre my patient" or something lame like that. but it felt great, because i was so nervous, and he was my first 'real' patient, and i was happy i was generally on the right track.

my second patient of the day was a woman who had a genetic condition that had caused both physical and mental delays since birth. she was wheelchair-bound and had to have all her needs taken care of by her mother. talking to the mother, i was totally amazed at her strength and ability to find ways to make sure her daughter was involved in family activities. i really didn't have a clue about lots of her medical problems, but tried to get social work involved because it sounded like she was having lots of problems coordinating care and payment of a lot of the things she needed to take care of her daughter properly. i haven't had a lot of experience with disabled people or patients, and hope to learn more in the future.

after my first clinic i was feeling better about myself. my medical assistant that helps me out, patience, and the supervising resident, liz, also totally saved my butt helping me figure out what - and where - everything was in clinic, and that i had filled in everything properly. next stop: night float.

there are two things you can do on night float: cross-cover (take care of urgent issues that come up at night for patients whose primary md's have left for the night) and admit patients to the hospital after the admitting team has capped (met their limit) or after a certain time (midnight?) so the admitting team can take care of the patients they've already got.

the first night at the hospital i was on cross-cover. the day float really took time to transition and orient me, which i was super grateful for, and then she handed me the 'float' pager. one of the first tasks that i was asked if i wanted to help out on was to try an arterial blood draw from a patient who was a hard stick because she had blown most of her veins injecting drugs. she was totally NOT happy to see us, and totally sensed that i clearly wasn't 100% confident about doing the art stick. she ended up yelling at me before i even got a chance to try and said she wouldn't allow me to do it, that there was no way i could possibly be a doctor. she also stated that didn't understand why she was being experimented on, and demanded that the senior resident supervising me try. the senior defended me (i was so grateful, especially since we had just met like 10 minutes before!), explained to the patient why we had to do the blood draw, and calmly convinced her that the procedure was necessary. unfortunately, the senior couldnt get it either, and the patient kept being belligerent.

after we left the room, i felt relieved and thanked the resident for sticking up for me. she was really supportive and said she was sorry to had to deal with that my first night, but i know i totally will have to deal with patients not agreeing with everything or totally trusting me. at the end of the encounter, the resident mentioned that she believed that the patient also needed to take responsibility for the situation we were in - if she hadn't blown all her veins, we wouldn't be having to put in lines or trying to stick her all the time to get blood. i hadn't thought about it this way before, and im still trying to wrap my head around how i feel about it. so that was my first inpatient experience at the hospital. the rest of the night went pretty well, and by the end of it, i was feeling pretty ok about calling a nurse back, ok'g orders, and being called 'doctor'.

tanyaporn wansom, md, mpp in thailand!

2009-07-06T17:17:00.009-04:00

not much to say about graduation. the end of the year was hectic for me, trying to finish up papers and projects for my last semester of policy school, making sure things were in order. i loved the policy school's speaker, bryan stevenson from equal justice initiative, and did not love the med school's speaker, sanjay gupta. i felt more a part of my policy school class (having spent the last three semesters with them) but still an outsider in a lot of ways. for med school graduation, a lot of my family came into town, which was great, but it was also weird thinking about finally having those letters after my name and being officially done with school. anyway, i didn't thinka bout it too much, and tied up loose ends in michigan pretty quickly after graduating to head off to thailand for a month to work/play with some of my favorite people!

i was kinda disappointed since i spent a ton of time applying for awards/grants and had received rejection letter after rejection letter until the end of april, when i found out that i had been awarded the jw saxe fund prize for public service to go to thailand and work with karyn at thai aids treatment action group (ttag). this was fab news during the midst of finals, and chris found a super cheap ticket for me to fly to bangkok on northwest even on really late notice. as the most supportive husband in the world, he also volunteered to pack and move our entire house to maryland. he is amazing, for sure!

so, thailand was totally amazing even though i was really stressed out about going. i was only there for a month, but still got to do a ton of stuff and be involved in projects im really excited about. quick snapshot of work-related activities:

Participated and helped out at a weeklong hepatitis c training for community advocates, iv drug users, and people living with HIV/AIDS in cha'am outside bangkok. two awesome trainers, tracy and lei, from treatment action group (TAG) in NYC led the training with karyn, and i jumped in and helped out with medical advice and other activities. this was the first time i was really called 'doctor' by everyone all the time, which took awhile to get used to, but was also kinda exciting! my most fave compliment was at the end of the training, when a woman (below)told me "i thought you were an iv drug user when we first started the training because you looked so tired and out of it (i had literally *just* gotten off the plane when we started), but then i realized you were a real doctor and your explanations really helped!"

Translated at a training for a study sponsored by UBC in Vancouver based out of Mit Sampan Harm Reduction Center in Bangkok. The study is basically a really long interview conducted by peers (former/current users) for users re: all kinds of risk behaviors, police interaction, health status, etc. My co-translators included an ex-physician who now owns a small bookshop catering to college kids and a transgendered woman, who convinced me to accompany her to a photography exhibit/benefit for SWING (Sex Workers In Group). as a previous volunteer at EMPOWER, i hadn't seen surang (the head of SWING) and tee for YEARS but they immediately remembered me at the greeting table and we had lots of hugs and catching up - i hadn't even been married the last time we'd seen each other, but good to know that i can return, and that people still remember me!

Wrote a brief report at the CDC on my project re: the use of Binax testing to detect S. pneumoniae from alarm positive, subculture negative blood cultures. Don't know if this is going to go anywhere, but hopefully something comes out of it.

Got hired by Karyn to write a policy brief for TTAG/MSF Access to Meds Campaign re: hepatitis C treatment access in Thailand; will also touch on issues in China and India.

Dave (Amalee's husband) hooked me up with some people at his work, the Mahidol-Oxford Tropical Medicine Research Unit (funded by the Wellcome Trust). They do some really interesting work re: malaria and meliodosis, and I'm trying to set up an elective in October/November with them in Ubon Ratchatani now!

So, the month was totally productive, but also totally fun! Highlights included:

A day trip to Petchaburi with Nan & company (what Chris refers to as "lez trip" - this was lez trip #3). A new girl came with us this time and brought two of her male cousins, one of which was Thai-American, like me! We spent the day eating massive amounts of food in a raised hut next to a river and floating down the river in lifejackets. It was relaxing and awesome.
Spa date at Divana with Tracy (Hep C expert!) and Karyn and Ott
Lounging around near the pool and on the balcony during the Hep C retreat with the gals
Dinners with a great couple, Paul and David, who have done MSF work in Thailand for ages. I was totally embarassed, however, when I drank a little too much wine at their place and ended up lying down on the floor of their bathroom while trying to not pass out.
Eating at new places in Ari and hanging out with Dave and Amalee
All-you-can-eat buffet madness with old Thai friends and new ones (from IFMSA!)
JJ Weekend Market and Katak and catching up with Nan

great trip overall, and i was really happy chris supported me in going. we'll be back in october for vacation!

matching and moving

2009-06-04T22:18:00.006-04:00

despite my best intentions, i again have fallen off the face of blogspot status post (medicalese for after) match day. the past three months have seen a ton of things fall into place, and i feel like my professional life - and my life with chris - is really moving forward. quick flashback to match day:

1) match day.
prior to match day, you submit your rank list and then wait for three weeks to find out the result of your match. i actually ended up making a lot of semi-last-minute changes after talking out things with chris and others, but ultimately ranked programs in the order i thought would best meet my needs (and also that of chris and yoda!)

the week of the match, you first get an email on the Monday telling you whether or not you matched. the night before this email went out, i told chris i was going into preventive med or something if i didn't match because i didn't think i could deal with the scramble.

while I was at the Ford School, a friend I met on the interview trail instant messaged me: "I matched! Check your email!" I quickly found the email with the subject line, 'Did you match?' and then you open it - I got, 'Congratulations, you matched!' . this was good, but i still had no idea where i matched - i had to wait for a few more days to find out!

on thursday, chris stayed home from work so we could match together. i didn't end up attending the school's 'celebration' because i knew very few people in the class i ended up graduating with (i entered with the class of 2007 and did three years with them) and just opened my match results on the computer. the subject of this email was 'Where did I match?'
and this is what i got when i opened the email:

March 19, 2009

AAMC ID: 11458085
School Code: 145
School Name: University of Michigan Med Sch
Applicant Name: Tanyaporn Wansom

Congratulations, you have matched!

Program Code: 1237140C0
Program Name: Internal Medicine
Institution Name: Johns Hopkins/Bayview-MD

i was kinda freaked out because i just read the top part, and was like, what, i matched at Michigan? but then kept reading and was really happy to see that i matched at Johns Hopkins Bayview Medical Center. i had done a 2nd look there over the winter holidays since we were down there visiting Chris's extended family and really liked the flexibility of the program, the residents, and also the ID faculty and substance abuse/HIV clinic faculty that i met with while at the hospital for the day. Chris was also thrilled because he wanted to be near his family and we knew there would be tons of jobs in the area, esp. with the government.

right after i matched, chris disappeared downstairs because he had been eyeing this job posting on monster.com for months. i helped him throw a cover letter together even though i was like, weh, i want to celebrate (but good for him to get a job too!). he was interviewed on the phone and then got called in for a hardcore all-day interview less than two weeks later. After the interview, he was offered the job right away. so that was cool - he is now officially assistant VP/network services manager at sandy spring bank, which is a local community bank with 50+ branches in maryland/dc/va. we both feel super incredibly blessed that he was able to get a job in this economy, especially one that would help him move into the management track and let him be based close to home.

my parents were super pumped to hear i was going to hopkins bayview although my mom was sad that i was (officially) leaving michigan. i finished celebrating with friends from the med school and Ford school at Dominick's.

matching is much more anti-climactic than you think it might be, but i think it's just waiting and waiting. it was exciting to get text messages from my friends matching around the country though and a relief to know where we were going to finally end up!

2) post-match day: househunting!

one of the chief residents who i'd gone to med school with referred us to his realtor, wendy slaughter (he chose her out of a phone book because her last name sounded like someone who would fight for you, and he was right!) after talking on the phone with her, she helped chris and i find a lender (and get pre-approved for a mortgage), narrow down our price range, and identify things that we wanted in a house (# of bedrooms, garage, stuff like that). once that part was done, she sent us all the listings that matched our criteria, and we chose around 25 that we liked from the ads/virtual tour online.

two weeks after matching, we headed down to maryland for the weekend, where wendy had organized a 2 day tour of all the houses that we liked. in between coffee stops, getting a little lost in her pilot, and snarky commentary all around, we narrowed down our field to two or three places. one of the places we loved was a foreclosure, and when the price dropped on it a week or so after we looked at it, wendy helped us put in a bid right away, hounded the listing agent until he got back to us, and advised us on what to do once multiple offers got to the table. luckily, our offer was accepted, chris was able to do the home inspection while he was in maryland for his job interview, and we got everything squared away for closing.

only chris attended closing so i could take acls and go to thailand (subject of another post later). most people thought it was weird that i wasn't present (it is our first house and everything), but you know, that's just the way we roll sometime. in the end, it was really fortunate that i DIDNT attend closing because i had to emergently wire $$ to chris - he learned the hard way that banks clearly DON'T accept personal checks for closing costs/down payment, and need a cashier's check. just an fyi for all you house-buying ppls out there. :)

ok, this is a good update for match and house right now. more and more updates to come!

it's been a long time

2009-03-01T08:26:00.004-05:00

it's been a really long time since i last blogged. looking at the time stamp of my last entry from thailand, it's been about nine months. im kinda shocked by how easy it is to let go of something you do so regularly because it's not a priority and you don't make time to do it. writing is one of those things for me, but i don't want it to be. it's just one of those things that's perpetually on my to-do list, and today i was like, i am writing a blog.

the task is sometimes overwhelming because the longer i wait to write, the more i don't know where to start. so much has happened since last june, in my personal life, and in the larger world as a whole. some quick snapshots:

the 2008 american presidential election (yay obama!)
finishing my 4th year of medical school with an emergency medicine at Henry Ford Hospital in the city of Detroit,
attending the International Federation of Medical Students' Associations General Assembly in Jamaica
meeting up with Liz and Suhani for a weekend in Denver (and having breakfast with Alex and her fiancee Matt)
going back to the Ford School for my final year and making some new friends :)
welcoming home the newest member of our family, a miniature schnauzer I named Yoda, from a local rescue
surviving the madness of interview season, emotional roller coaster waiting to be offered (or not be offered) interviews, scheduling travel to and from the airport, thirty flights in a little over thirty days, crashing on friends' couches, loving/hating places i didn't expect to, keeping an open mind, testing my small talk skills, the finality of the rank list, waiting waiting waiting...
chris joining me for weekends in new orleans, seattle/portland, and christmas holidays in baltimore/dc, exploring new places, falling in love with new orleans, the prospect one exhibition, the lower 9th ward, the devastation of katrina, rebuilding and ghosts and roots and houses, and understanding a little more about catherine and her love and her life there!
spending three weeks in South Africa, first time to the continent, two weeks helping to teach a STATA workshop at university of capetown, living in a dorm again, connecting with new people, mountains, oceans, animals, confronting poverty and racism and hope, one week traveling with Chris in Kwazulu-Natal, more on this later...
trying to keep up with working out at fitness together (the personal trainer/fitness studio), losing close to thirty pounds in a year! and feeling good about myself!
spending a lot of time at caribou coffee and having an elderly man tell me my smile was a gift :)
the requisite AMSA stuff, being chair of the Global Health Committee again, and being excited about the future of AMSA and helping people go abroad and find their paths and dreams!
realizing i'm going to leave michigan after six years and being happy and sad about it all at once! yesterday we spent time with a lot of different friends here - breakfast at northside grill with michelle and brian debbink, lunch with rollie and meena, cora's first birthday party at emily and ali's (and chatting with paula anne and kevin), joey's birthday with all the fitness together trainers, and coffee with nick (chris's coworker) and his gf joanne. i was like wow, we have a great community, and we're leaving! but it's totally time too!

so this is my first blog and im excited to be back!

leelawadee

2008-06-03T05:36:00.002-04:00

the leelawadee flower (known as rangipani in English) has emerged as a theme from my short six-week stay in thailand. a super fragrant flower, it was previously named lan-tom and not grown domestically because it was associated with temples and its name also reminded Thai people of ra-tom, which means sorrow. H.M. Sirinthorn renamed the flower to leelawadee, and since then its popularity has soared among Thais throughout the country.

my leelawadee experiences have included:

1) Going to Leelawadee spa with Karyn, a good friend from TTAG. There I enjoyed a great foot massage and also a Thai-style facial, which involved some sort of honey scrub.

2) Eating at Leelawadee restaurant with Nan and P'Dong around Ramkhamhaeng - super yummy food, live music, and nice Thai-style decor (refer to previous entry).

3) Receiving a Leelawadee Madam Heng gift set (two bars of soap, one shaped in the form of a leelawadee flower) from my mom's seamstress, who i also visit when i come here. This gift set commemorates the King's 80th year on the throne.

All these Leelawadee experiences happened during different weeks of my stay, but constantly reminded me to appreciate the vast amount of natural beauty in gardens (even within the madness of Bangkok).

nakhon phanom

2008-05-30T01:01:00.002-04:00

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!

working at the ministry

2008-05-20T05:18:00.003-04:00

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!

back in bangkok

2008-05-18T23:01:00.003-04:00

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!

hope and inspiration

2008-04-20T16:11:00.003-04:00

ive been fortunate enough to listen, learn, and be inspired from various people the past few weeks. here are a few scattered thoughts about these diverse encounters:

today, chris and i joined thousands of other people in Crisler Arena to hear His Holiness the 14th Dalai Lama give the Peter Wege Lecture on sustainability. we got there early and had pretty good seats showing a profile of the Dalai Lama. even though we were all packed in, i immediately got the feeling of compassion - or loving kindness - that i was in the presence of someone at inner peace. the dalai lama was humorous, was humble, and most of all, he was real. i think that's one reason that i've been kept grounded in the faith of my parents, in Buddhism: like the Buddha, all those who provide us with advice or direction are real people, and they embrace their own humanity. some points the Dalai Lama talked about in his lecture (in no particular order) included:

-the gap between the rich and the poor, and how a lot of our (Western) lives are both unsustainable and overindulgent. he noted the paradox that many of us find ourselves in when valuing material happiness over spiritual happiness - although there is a limited amount of happiness to be found in material goods and the physical world, we fixate on having more, or believe that the next thing will bring us happiness. on the other hand, there is unlimited happiness to be found in inner peace, in compassion, and in ourselves. sadly, very few people decide to nurture or focus on their inner happiness, and suffer as a result.

-valuing humanity by realizing that the potential (in terms of compassion, or "warm-heartedness") of all humans is the same due to the ways in which we are brought into and nurtured into life. i think this was a little different perspective on 'human rights' as ive learned it, but was refreshing to think about as a practical approach to looking at human emotions and values.

-the importance of diversity (in religion) of addressing different times, needs, cultures, and places...although all of them do have similar overarching messages, it is important that they all exist because they provide different approaches for the differing needs of the world. the importance of dialogue in recognizing the beauty and strengths of each belief system. collaborating together, building community to achieve a common good.

-the need for non-violent approaches to solve conflict in the increasingly interdependent world. war as an outdated mode of resolving issues. nobody wakes up in the morning saying, "i hope to make an enemy or get in a fight today!" even with the best intentions, unfortunate things still happen. if you believe in karma, how you react to those situations will determine future events - so it is important to take care of the present, to make choices reflecting the positive effects you want to have in your life (and others).

-the need for community (and the need to see community as including even those who don't agree with you). although he didn't say that explicitly, i thought of it when he was talking about dialoguing and exchange between different religions, and how he tries to engage in that exchange whenever he can. one example he gave of was when he went to the UK and was invited to be a part of this seminar where he had to give lectures about different passages from the Gospel (and inserted some Buddhist perspectives). he described the experience as super challenging (but also fulfilling) as he was trying to lead discussions to believers as a non-believer (and that he had to learn and read the passages the night before as "homework"). many Christians at the event appreciated his lectures and later came to India to participate in meditation retreats and Buddhist lectures. this was a pretty cool example, and made me think about how i (or we) so rarely engage those that are not already part of our value system, and how we should maybe try to do that more in either our daily lives or in the work that we do.

going back to the theme of community, i was really honored to be part of a panel that celebrated the opening of this new exhibit at the National Library of Medicine at the NIH titled "Against the Odds: Making A Difference in Global Health." kevin burns nominated me to be in it, and staff interviewed me a couple of months ago to put together a short profile on me for the "ordinary people" part of the exhibit at the end. anyway, to celebrate the opening of the exhibit, there was a panel of people featured in the exhibit speaking to a few hundred local area high school students, which was pretty cool. i was totally inspired (and humbled) to hang out with and listen to speeches by Dr. H. Jack Geiger, one of the founders of community health centers in the US and co-founder of Physicians for Human Rights, Dr. Victoria Cargill, Director of Minority Research in the Office of AIDS at NIH, and Jeanne White-Ginder, the mother of the late Ryan White. before the panel, i got to enjoy almost an hour of good one-on-one time with Dr. Geiger, who regaled with me stories of S. Africa during apartheid, cases he got during his oral boards, and why it kicked ass to be an emeritus professor. he also gave me some good career advice and was just really honest and down-to-earth.

Dr. Victoria Cargill talked about running a health clinic out of her beat-up car, getting hepatitis as a resident from a needlestick and the inhumane ways she was treated by her own fellow residents, and how she never takes "no" for an answer (fave quote - when somebody says "no" i flip it in my head to "on".... BRING it ON!) Jeanne White-Ginder talked about how ordinary people can be called to do extraordinary things, and how she just tried to be the best mom she could be - before, during, and after Ryan's life. all of it was really super amazing. if you want to see the podcast of the panel, you can check it out here. Also, the interactive online exhibit can be found here. Shout-out to Hanni Stoklosa, who is also featured in a video interview in the exhibit and also online. it is really an honor to be part of a community and a movement that includes really amazing inidviduals like Ryan White and activists from ACT-UP. it is important to remember where we came from, as activists, and as people. sometimes it's hard for me to keep that perspective because i'm always used to looking forward to the future, to the next action, to what we have to do to try and make the world a better place. i realize that i don't think often enough about the past, about lessons learned, about the people who came before us, about their struggles and their strength. watching the interviews with ryan white and seeing his mom speak then, and now, i was pretty overcome by the maturity and the wisdom and the courage a young person like he could summon. it was the same kind of inspiration i felt as a young person reading his autobiography. wow, i thought - i haven't thought about this in a long time, and it feels good to have that connection again, to revisit one's past and connect it with one's future. i was thankful to be given the opportunity to make that connection, and i feel like that's what i hope to do through my writing, for myself, for whoever reads this - make connections between the past and the present, and the present and the future....

lately, for me, ive been thinking a lot about connections, about community, about how my experience fits into the larger human experience as a whole. there was a pretty cool talk by faith fitzgerald titled 'what is a human?' at the global health education consortium conference (follow the link for more of a synopsis on some of the events) in sacramento that touched on parts of humanity, and connections i had with both friends and colleagues there made me really happy - and hopeful - about the future. i spent good quality time with rohan, who gave voice to many commuter night children in uganda, heidi, a ghli'er who recently married a co-worker from cameroon, jen cohn, who is going to lead an awesome global health residency in medicine at penn, and dan, who wrote a kick-ass script for the pepfar call-in i added to the end of my presentation on the global health workforce crisis and bought me a drink at one of his favorite dive bars in his hometown. finally, i also shared fuzzy fleeces (& yummy ethiopian food) with hanni, amsa-ifmsa co-chair. it was good to make those connections and it was good to bring some action and advocacy to a venue which traditionally hasn't been organized in that way. i was approached by more than a few people (academics! physicians!) who said they hadn't done a call-in before, and it was so easy, and they would totally do it again. this was kinda sad, because these people have so much power, but then also kinda exciting, because they realized how easy it was to use that power to make a difference. i hope there will be more organizing and advocacy at ghec in the future, and am looking forward to more student involvement and direction as we move forward.

finally, i just want to say that i feel so blessed (in so many ways) to have a community that continues to inspire me. whether that's through an activist speech making students think about systematic change at a community service awards ceremony (yay rishi!) or posting an inspiring, amazing blog (yay cj!) or helping me connect to a memory of the past (multiple people, multiple ways- more on this later!), i never imagined as an awkward, gangly, angsty teen that i would be surrounded by so much love and hope. besides world peace and access to health care, education, housing, and food for all, im not sure there's much more i could ask for ;)

soros

2008-02-17T10:37:00.002-05:00

so, during the madness of the end of 2007, i threw together a soros application and was super excited to get a phone call at the end of december saying that i had gotten an interview. i ended up going through the interview process a few weeks ago in LA, and got my rejection letter from them yesterday. the letter opened with, "i wish this letter could bring you good news. it does not." ouch. luckily, i had kinda been expecting it because their webmaster had put up four names for 2008 winners that was later taken down. however, i figured that because i hadn't heard and winners were already posted, i probably wasn't one of them.

the soros fellowship for new americans is a pretty cool scholarship - they pay half your tuition for grad school and then give you a stipend for 2 years. i was able to apply since im doing the MPP now and it's my first year. it was a super intense application, and i really am thankful to everyone who helped me put it together, including all my friends who read drafts and commented on it, my recommenders, and of course, my IT-savvy husband chris, who used 'Snag It' to make exhibit upon exhibit. although it was the hardest application i've ever done, i don't regret doing it, and helped me put things into perspective around the same time i was applying to the Ford School.

each finalist had two 30 minute interviews with panels of five people at each interview. the panels were made up of previous soros fellowship winners, some people from the foundation, and other New Americans. i thought my second interview went much better than my first, but who knows, really. some interesting things i gleaned from my interviews was that "AMSA is really radical" (answer in my head: what's radical about wanting people to have health care?) and "Don't pharmaceutical companies need to be compensated for all the R&D they do?" overall, the conversation was mostly enjoyable, but i was afraid after the first interview that i didn't articulate myself well enough, and maybe revealed things that caused them not to really like me in the end (like failing step 2). however, i was really proud of some of my answers, including one of the final questions in one of my interviews, which was "What do you want to be known for when you die?" My answer - and I didn't even really have to think about it - was

"I think it would be awesome to implement a policy that would radically change poor people's access to essential medicines, or find a cure for HIV/AIDS..but what I really want to be known for is that regardless of what I accomplished in my career, I remained grounded in the community, and represented their wants, needs, hopes, and dreams accurately. From my work so far, I don't want to be the person who just comes in and tells people how they need to live their lives, or what their interests need to be. If, when I die, the marginalized people I have worked with respect who I am, what I did, and saw me standing in solidarity with them - then that is the accomplishment I would be most proud of."

i got the feeling that some people thought that was a copout, but i really meant it. i'm not sure how the soros values community work (or other grand fellowships for that matter), but it sometimes seems that academia and other institutions don't place as much value on it as 'traditional' work, like how many papers you've published in peer-reviewed journals, or whatever. in some ways, my 'years off' in thailand haven't been successful in that measure, but on the flip side, i'm proud that i had the gumption to go out and seek community work with commercial sex workers, or iv drug users, or just women who needed to get an abortion in a place where abortion wasn't legal. beyond that, the lasting friendships i've made and the maturity i've gained from recognizing that it doesn't matter how old you are or what the social hierarchy or whatever - you can still help others (and mentor them!) in so many ways....that work has been the most important to me. it's made me who i am as a person, and who i hope to become.

in the end, i have to say that i was super disappointed not to win. i'm also kinda kicking myself for not applying for the FLAS (Foreign Language Area Studies) grant, which is less competitive and just for University of Michigan grad students. At the time, i didn't have my stuff together and wasn't sure if i would be able to commit to taking Thai for the whole year. it's ok though, life goes on. and i have to say, i super love my life overall. going through this process has really made me appreciate my family and friends (and googlechat). just like i said in my answer to what i want to be known for when i die, im really honored to be respected and loved and (maybe even looked up to) by all my friends - all of whom inspire me as well.

my friend sarah and i were talking about her rank list the other day, and about soros, and about academic elitism and how that impacts our lives and our choices. i am proud of myself for making the choice to stay at michigan and i am proud of my friends who make the choice to do what is best for them (in their lives) over what would generally be seen as "the best" by society, or your family, or your department chair, or whoever.

finally, i am so grateful for all the love and positive feedback i've been given over the past few weeks. this is from anjali last night: "whatever rhodes scholar. whatever robert wood johnson clinical scholars. whatever whatever. seriously. you're the shit and you've gotta keep believing in yourself. half the people who do these scholar things are really doing it for themselves and don't have a bigger vision in mind you're going to go SO far, and be respected by the people." sometimes i worry about how much of it i am doing for myself, and recognizing that even though that is a part of it (and that's ok), i definitely do not do the work that i do just to be congratulated on by someone else. i do it because i care, because im a woman of color, because life isn't fair, and because i have so much privilege it would be ridiculous and almost criminal not to do the work when people half as privileged as i am are fighting and struggling every single day.

thanks to all of you who do the work that you do. i am honored to be part of the movement.

back at it

2008-02-16T19:01:00.003-05:00

hi everyone! i know i haven't written in forever, but im trying to get back on the blogging bandwagon. life (as always) has been crazy, and i've had my share of ups and downs over the past few months. a quick update of what i've been up to:

1) Starting my MPP (Master in Public Policy) at the Gerald R. Ford School of Public Policy at U of M. This semester has totally flown by already and I'm about halfway through the Winter term. Going back to my nerdy Swarthmore ways, I decided to max out my credit limit and take six classes (a regular full-time load is four). If any of you are wondering, my classes include:

Statistics
Public Management (The Politics of Bureaucracy)
Political Environment of Policymaking (focusing on science/technology policy)
Research Seminar on Science, Technology, and Public Policy
Health Care Reform (taught by Matt Davis, my advisor (also MD/MPP) and
Health Economics and Public Policy

I've been enjoying myself so far and keeping myself busy writing papers ranging in topics from why the CIA and FBI counterterrorism efforts failed before 9/11 & how their cultures reflect failures in public management (national intelligence is really siloed and interesting, actually) to an economic policy review of President Bush's proposed tax code reform to take away the favorable tax treatment of employer-based insurance and instead give all insured people standard tax deductions. Besides the academic part of it, I've started to make some friends who are also in my policy school classes. The fun thing about it is a lot of people are doing dual degrees in the policy school, so there's students from all different departments participating in discussions and things.

The Ford School admin overall has been super nice and supportive as well. I've been surprised at the lack of political advocacy that goes on in the student body (although I may be out of touch with what goes on after class). Being so heavily involved with AMSA and trying to include advocacy and activism in my daily life, I am kinda shocked that most people in policy school seem to be like most people in med school (although the policy people are more liberal overall). What I mean by that comment is that I feel that most people aren't making calls to their legislators, or paying attention to action alerts, or coordinating call-ins. To my knowledge, there has been no political action at the Ford School this semester and the student groups overall don't seem very politicized, but I do admit to having a limited knowledge of what is going on. If anyone wants to share other knowledge with me, I'm totally all about it. I also might try to shake things up once I get more situated ;)

2) AMSA

My life would not be complete without mentioning AMSA, of course. In the past few months, I've spoken at the first-ever premed Global Health Leadership Institute (amazing job organizing Courtney!), helped get together folks to lobby around PEPFAR (the President's Emergency Plan for AIDS Relief) reauthorization, and participated in the first-round interviews for the new AMSA Executive Director/ CEO (who was just named yesterday - yay!). I've been inspired by my colleagues, energized about the work, and happy to be a part of the movement. Some highlights of being down in Reston include:

-Thai dinner with Dr. Bill Kessler, former AMSA pres who formerly worked for the CDC and now is at the Center for Medicare and Medicaid Services in New England. We had a good chat about Thai food in general, my career, and how CMS and others decide what measures to focus on in pay-for-performance schemes. It was also great to be on an interview panel with some former AMSA presidents (who now serve on the AMSA Foundation Board) and see how they interviewed candidates and what they picked up (and didn't) in our group interviews.

-Watching the Super Bowl with Paige, Josh, Dawn (intern from Penn State and Sural's classmate), Adrian, and another intern (doh, I forgot her name). Yay Giants!

-Minerva (best Indian food ever!) with Dan Murphy

-Waking up at 3 AM to see drunk Paul Davis and Kaytee outside my door getting ready for Premed GHLI lobby day on PEPFAR reauthorization!

-Meeting new people and getting pumped about the future of AMSA!

3) 2008 New Year's Resolutions

So back in December, I was feeling kinda down about myself and about studying in general. I was unhappy about the 40+ pounds I've put on in the past three years, and I wanted to do something about it. I also realized that it was going to be tough to make major lifestyle changes if Chris wasn't on board....so I basically dragged him along with me and signed us up for a 16-week package at Fitness Together (FT) , this personal trainer place that's about a 2 minute walk from our house. Although he wasn't so gungho about it, he knew I was really unhappy and made the commitment with me to lose weight, get in shape, and stop eating such a crappy diet (we basically ate out everyday for dinner, and sometimes for lunch as well). Although this has been one of my New Year's resolutions before, I really wanted to keep it this time, and throwing down a bunch of $$ and making appointments/commitments seemed like it would get our butts in gear. You know what? It totally has!!

Basically, since Jan 2nd, we've been going to FT three times a week for 45-minute strength training sessions with personal trainers (aka getting our asses kicked). The first couple times were really painful, but it's been getting a lot better and both Chris and I have gotten a lot stronger even in the past six weeks. In addition to the strength training sessions, we're responsible for doing cardio at least three times a week. We bought a treadmill and have been running since mid-January (I totally prefer the elliptical, but running is the best!)

We've also been keeping these "accountability food journals" where we write what we eat everyday and then have our trainers review it once a week. We've been using a lot of recipes from the Eating for Life book and follow a diet where we eat every 2-3 hrs (so 5-6 times a day) and make sure every meal we eat contains a carb and a protein. The point of it is to maintain blood sugar levels throughout the day so you don't go starving yourself and then totally overeating when you get super hungry. We keep the diet six days a week and then get a "free day" where we can eat whatever we want. So far, it's been going really well, and Chris & I spend a lot of our time cooking together instead of going out. We also feel really good about ourselves and it's fun to keep each other in check! I am totally proud of Chris for *finally* cutting pop out of his diet as well.

4) Getting on good terms with the in-laws

Yay! Even without taking any classes on negotiation and/or conflict resolution, I was successfully able to negotiate a weeklong 'vacation' with my in-laws in LA. Bonding activities included playing with my niece Melanie (im actually not that bad with kids!), eating lots of Chinese food in Monterey Park, and spending a weekend in Las Vegas at the Wynn Hotel with Chris's parents. While in LA, I also got to visit AMSA friends & previous JRF's Anjali Taneja & Casey Kirkhart, drink lots of bubble tea at Lollicup, go shopping with Chris, and actually have LA grow a little bit on me. Perhaps the West Coast may be in our future...

getting my life back...in order

2007-12-06T10:50:00.000-05:00

i don't like disorder (but mostly in a larger, life-picture sense). my room is always messy, i tend to make piles, and i often enlist the help of chris to find (or remember) where i've placed various objects. however, there is always a grand plan in the works.

over the past few months, my grand plan was derailed a bit. everything was on track until i didn't do so hot on a standardized test. this caused me to rethink the life plan for the year and decide to:

1) Not graduate from med school this year and
2) Not match until 2009.

because of this decision, i had to figure out something to do for 1.5 years. as i had always been toying around with the idea of getting another degree, i decided to jump in and explore my options. again, there were many options:

1) Master in Public Policy (MPP) at Michigan's Ford School of Public Policy
2) MPH at Harvard's School of Public Health (SPH), Johns Hopkins SPH, or UM SPH
3) Apply for another fellowship like Doris Duke to go abroad for a year
4) Work!

this was a really tough decision for me but on the advice of some mentors, i decided to stay at michigan since it was the only place i could get my MPP in the time frame i had. the MPP requires three semesters (rather than two) and gave me more opportunities to explore and be exposed to topics i haven't covered before (like economics and health care financing). don't be fooled into thinking this was purely a career-based move, however. in fact, this decision was one of the hardest decisions i've made because it was one of the first major decisions where i actually took something else besides my educational/career goals into account.

growing up, i always thought my education and career would come first. i was confident my family would support me and didn't think too much about where my partner at the time would fit in. usually he would come along or be supportive and if he wasn't, i wouldn't let that get in the way. working against my love life, i left home, went to swarthmore, then china, then thailand. boys would never hold me back.

it looked as if a wedding wouldn't stop me. i was gone for months in geneva and then bethesda leading up to my own wedding in michigan. chris was truly committed, buying a printer and sending out all our wedding invitations (he even kept track of RSVP's!) the day after we got back from our honeymoon, i got on a flight to thailand to start my fogarty year.

even though thailand was a second home to me, chiang mai was new territory. the id fellow (poo) and her fiancee at the time (p'nui, now her husband!) took me under their wing and i definitely love them for it. it was weird to be alone. i missed chris a ton and wanted him to share in the experiences i was having in thailand. a few months later, he quit his job and came to live with me. everyone thought it was crazy, but we had a wonderful time overall. and chris got a new job when he got back!

when all this decision-making was happening, chris was completely supportive. he wanted me to make the decision that was best for my career. my parents were gung-ho about harvard. as asians, they passed along their love for name-brand education + prestige to me. i don't like to admit it, but there is a part of me that does buy into academic elitist thought. even if it wasn't the best program or the program that met my needs the best, i couldn't dispute the importance and the wealth of connections to be had there. friends offered to talk to people. i was paralyzed by the choice i needed to make.

in the end, i only applied to the Ford School. i convinced myself that i wanted the MPP degree, and this was the place i was going to be able to do it. i'm the first MD/MPP candidate here and am excited about it. people have been incredibly supportive at the Ford School, which is a nice change from some of the challenges i've had to deal with from the med school side of things.

honestly though, what it really came to down to was putting my family first. staying at michigan meant staying with chris and being able to see my parents every weekend. even though chris volunteered to fly to boston or baltimore or wherever i ended up for the year and my parents totally thought i should do it, i knew it wouldn't be good for us. and it wouldn't be good for me.

even though i do feel like i'm mostly an independent woman, i am really much happier when i'm with chris. this was really highlighted to me when both an american friend and a thai friend noted the difference in how i was as a person before and after chris came to thailand. was this a sign of weakness? i used to think so, but not so much anymore.

a high-ranking indian doc in the UN came to speak to a group of med students a few months ago. i asked her how she balanced her career and her family. her answer was:

"i've always told my husband: children first, career second, husband third." she smiled. i laughed, and said i would tell my husband that, but it made me sad. i know i couldn't do the things i do without chris's support. sure, he wasn't who i envisioned i would necessarily end up with - he wasn't an activist, or an intellectual. he WAS a fraternity leader and he was actually pretty conservative. over time, he's definitely come around (no more shopping at Wal-Mart for starters!) and he helps me do the work i do. most importantly, he's never made me choose (or feel like i had to choose) between our relationship and the time i sometimes over-commit to education, activism, or service.

in the end, who are you without the relationships you have with people? i am eternally grateful for the relationships i have with my family and my friends. i'm pretty confident i'll continue to have a productive career, but i don't want it to be at the expense of who i am.

i've had this discussion with a lot of close girlfriends over the past few months who are making similar decisions about residency, or whatever next stage they're moving to in their lives, and i think we're all moving in this direction, recognizing that there are different things that can make you happy and feel fulfilled. most importantly, it's not copping out to make decisions based on these things, even if it's not found on your CV or something that's going to go on any application. more than ever, i've come to realize that mental health and overall life satisfaction/happiness is way more about the intangible things (like friendship) than i used to ever want to give them credit for.

maybe it's taken me awhile to realize this (as i strive to be an overachiever), but it's becoming easier everyday that i continue to work on it. thanks to everyone who's been so supportive! :)

two sad things, one happy thing

2007-10-23T20:27:00.001-04:00

i have a few unfinished blog posts rolling around, but i wanted to take a little time out to share these three things.

first, the sad things:

1) after an elderly family member of a patient i saw in clinic found out i was interested in health policy, he proceeded to share his views on health care with me. the highlight of this conversation was (and i QUOTE)

Man: "I don't believe anyone dies from lack of health care."
Tanya: "Really? That's an interesting thought."
Man: "Yes. Everyone can afford insurance but they choose not to buy it. Who can't afford their medications?"
Tanya: "Well, I see lots of people who can't afford their medications."

Conversation ends when the actual patient returns to the room from a bathroom break.

2) two other med students (and myself) attended an evening session called 'Malaria Boot Camp' hosted by Nothing But Nets, a campaign co-sponsored by the UN Foundation and inspired by a campaign started by Rick Reilly, a columnist who writes for Sports Illustrated. His 800 word column asking people to donate $ for nets raised hella money from a segment of the population (men) that were largely previously inactive in global health. At the malaria boot camp, a famous scientist from MSU spoke about how he helped develop a new long-acting insecticide treated net with the private sector. this was cool because the net didn't need to be retreated & lasted for about 5 years, among other things. In the Q&A session, i asked a question (surprise, surprise).

Tanya: 'Dr. Wilson, you've dedicated your career to trying to help those who suffer from malaria around the world. My name is Tanya and I'm here with a group of students from Universities Allied for Essential Medications. Have you considered humanitarian licensing or have you taken other steps to ensure that the fruits of your research will be available to those who need them most?"

Dr. Wilson: 'I really don't have control over anything because it's completely funded by the private sector. I hope our net is brought to market, but that's not my choice.'

Tanya: 'Do you retain any control over the patents or intellectual property used for the invention of the net?'

Dr. Wilson: 'Unfortunately not; the company retains all the rights."

Dr. who is running the whole panel and is the Director of Global Health: 'Excuse me. Public health people like Dr. Wilson who are dedicated to researching issues like malaria do not concern themselves with marketing. We are out there to try to help people, not market things." He says this kinda huffily and turns around nodding to the other panelists like they should back him up.

I was totally offended! As a leader in public health, how can he say that marketing is totally not relevant? An analogy to medicine would be that we only care about treating our own individual patients and improving their health but don't care at all about the health systems we work in. After I told this story to my brother, he even said, "What's the point in inventing an awesome net if it's never distributed to the people who will actually benefit from it?"

Frustrating.

Happy things:

Thiru nominated me for 'Most Likely to Make a Difference' on Facebook. Small, i know, but it totally made my day.

Patients also make my day a lot in clinic. Sometimes I know it's ridiculous to gain so much ego boost from little comments people make, but it seriously does go a long way. Some of my faves from this month:

"She is the best med student in the whole med school!" - from a professor to a patient after she offered me a position in her husband's cardiology practice.

"Hey doc, she's really good." My attending looks around, confused. The patient points to me. "She knows how to explain things so that I can understand!" Attending: "Oh, she has to be good. She's a Michigan medical student." (Thanks, Doc)

"You better be here when I come back! I only want to see you." Sorry, I'm rotating off - and I'm just a med student.

even when i don't know the answers to questions when i'm getting pimped, i know that i'm good with - and take good care of - patients. clinic is also a lot more fun than i thought (props to all you people in primary care!)

things that have made me smile recently (and boy, there have been a bunch!)

2007-10-01T07:29:00.000-04:00

trying to get back into blogging and realizing part of the beauty of it is that i can just write little tidbits of things rather than drawing out some large parallels between my life and the great truths of the world...er, you know what i mean.

it's 7:30 am. i'm starting outpatient cards today after being out of the hospital for a month. should be a nice switch from the MICU, but not such a sweet change from 'vacation' (ie studying and doing AMSA stuff like crazy month). since there's not much time, im making a list and going back to the topic of my blog - things that have made me smile recently. these are in no particular order.

1) i always thought i wasn't really good with kids, but decided to volunteer as a 'big sister'/'mentor' for this adopted asian girl anyway as part of a pilot program called GIFT (Growing in Friendship Together). most of the mentors are college kids that are also adopted, and all the mentees are Asian girls who have been adopted. we have group activities about once a month and then we also meet with our mentees separately. last month was the first month where both me and my mentee were able to join the group activity, where i met the other girls.

a month later, i emailed one of the moms who was helping out with this month's event (the Moon Festival, or zhong qiu jie, held last Friday night) for directions. she emailed me and said:

Hi Tanya,I've attached the flyer. Also--funny thing. K. just got a stuffed leopard and she named it Tanya. I asked her why Tanya and she said "Mom, you know--Tanya like the cool woman from mentoring?" She is such a watcher, she's clearly checking out all the mentors even while hanging out with her own.

That totally made my day! I was kinda feeling out of place before since I was one of the oldest mentors, but it's cool how something little like that can definitely make you feel like you're doing something right. later, at the Moon Festival, each pair of girls had to make a poster with pics and tidbits of what we liked doing together, what we learned about each other, etc. my mentee wrote (verbatim) 'I like evrything about Tanya!'. yay mentoring (and being a role model) for other young girls!

2) Finishing Cecil's. Yep, I read all 1100+ pages of the 'Essentials' version. I think I'll try to skim again, but it was not bad after you got into the groove of it.

3) AMSA family. Ah, AMSA is like a drug...gives you the high, but then you can never escape it. I spent a long weekend at AC Exec/GHLI and I totally got sick afterwards from not sleeping enough and being in intense meetings for a ridiculous number of hours each day, but it was really amazing. A shortlist of things that made me smile (will continue later since Chris is dropping me off at the hospital in five mins):

-getting lost in Dan's truck on the way to the retreat center with CJ and Dan Murphy. Fresh baked goods from Mom's Apple Pie Bakery. Trying to squeeze in and still drink our morning coffee.
-im'g/googlechatting with dan and vishad during the super long meeting
-late-night conversation and franzia sangria (with sliced apples) courtesy of julia
-encouraging people to listen to their hearts. kicking certain people out after it was way too late.
-writing my own global health vision statement.
-driving and walking with flavio for lobby day in DC
-late night talks, leftover chinese food, and capoeira performances at the AMSA townhouse
-having some really short (but valuable) quality time with rishi in the 10 mins we overlapped at ghli
-eating a homemade meal prepared by a lot of the male partners at ac exec - so nice to get out of meetings and have yummilicious food waiting for you
-teamwork (on a huge number of levels)
-watching 'the office' parodies done by med students about small group

ok, gotta run. more to come soon! it feels really good to blog again :)

continued from cards clinic (where I was actually sent on an unofficial consult to the hospital with the other med student on service..):

i'll continue on AMSA later. but, other things:

4) liz's eval of me (see 'comments' under previous blog entry). i dunno why, but evals like that make me feel so good about myself! am i a nerd? yeah, totally. do i like it? yeah, a lot :)

5) meeting up with suhani for sushi at DTW. i am starting to really get into airport dates. my first was with dan a few months ago at Dulles, where we had dinner and chatted, and this was my second official one with suhani. i havent seen her since she moved out to madison, and it was awesome to catch up, get some hugs, and to just spend some time with an old friend.

6) spending time with sup and karlo (two Ford School of Public Policy grads and APA caucus peeps) in dc, and grabbing dinner with davekumar. i was in dc a few weekends ago for this hiv psychiatry training and the american psychiatric association fall components meeting. the training was pretty good, but the highlights were definitely hanging out in a hotel room at jw marriott downtown, going to the adams morgan street festival with karlo and sup, visiting them in their place near dupont circle, and eating dinner with dave. i also met some cool people who are into global psych and caught up with roxanne, who was a global health fellow in geneva.

7) seeing patients again. a friend questioned if i was still into clinical medicine, and i have to say, i am! i saw a consult today in the hospital and really enjoyed looking up the history, taking notes, and talking with the patient. although im taking a year off, a mentor told me that i should try to keep my clinical skills as intact as possible, and i think i'm going to try to work with docs i respect in clinic if i stay here on my year off (which im really leaning towards doing).

8) family time! i see my parents almost every wknd if i'm around. they've been super supportive and really never fail to put a smile on my face, especially when we're ragging on my dad for being his silly self.

unchecking some boxes and shaking things up

2007-09-28T09:36:00.000-04:00

so i haven't blogged in a long time. i have been busy, but i've also been thinking a lot about where i am and where i'm going down this pathway of life. i've been reflecting on failure, on what that means to me, on what has to be different the next time around. thanks to all of you who listened to me in call rooms, on the phone, in your living room, or over instant messenger. im always impressed by how forgiving and supportive friends and family are when im confronted with their reactions and compare them to my own.

it's interesting how failure can overshadow all the other successes in your life. it's irrational, but it's the way many of us, especially in med school culture, are programmed to work, our self-worth tied not to how well we take care of patients or our relationships with others, but on evaluations, standardized test scores, grades. i try to remind myself to judge myself by other criteria too, but no one is giving me an end-of-the-month evaluation on what kind of leader, friend, wife, or daughter i am. i don't get graded on what i contribute to the community, the number of emails i send, or how i love. one thing ive definitely realized through my most recent setback is that i love my life and i love the communities i live and work in. ive also become a lot more comfortable talking about failure and not being embarassed about it. indeed, i think that admitting to failure and dealing with it (both privately and publicly) is one of the hardest things i've had to do.

when i found out that i failed, i felt as if i had taken a majorly wrong turn in the maze of life and i wasn't sure if i was going to be able to recover, to advance to the next level (power up!) or to put a band-aid over my damaged self-worth. luckily, my go-get-em personality and overwhelming desire to make to-do lists took over. is it painful to know that some boxes you checked off with a flourish must now be unchecked? yes. however, is it fun to make a whole new series of boxes and schedules with different permutations because you suddenly have a lot more time than you had originally anticipated before graduating? TOTALLY. yes, i am a nerd, and yes, i do think that it is super awesome.

since im not graduating for a whole another year (spring 2009), i am applying to a series of dual degree programs. right now, im pushing to try and do a MPP (master's in public policy) over an MPH (master's in public health), but will be happy to also do an MPH with a concentration in health mgt and policy. i had originally thought to pursue these degrees sometime during residency/fellowship, but am super excited about doing them now. yesterday, i went to an information session at the Ford School of Public Policy (here at UMich) about the Science, Technology, and Public Policy graduate certificate and became totally pumped about being a graduate (and not professional) student. more on this to come!

to-do lists

2007-08-13T17:19:00.000-04:00

ive always had an affinity for to-do lists. i think this started in high school, or even before, when i felt like i had a lot to juggle and needed lists to keep it all straight. my mother is primarily responsible for my obsession with multitasking, as she thought it was important to sign me up for every extracurricular activity available in a 1-hr radius of our little island hometown. if you dont believe me, here is a list of all the activities i participated in as a youngster: taekwondo, ballet, tennis, piano, art, writing, swimming, soccer, t-ball, basketball, community service clubs, tutoring, buddhist school....ah, the list goes on. ever wonder why im so involved (or obsessed with instant messaging while im on the computer)? ask my mom. even as a now-married pseudo-grown-up, ive taken multi-tasking to a whole different level.

i think this multi-tasking will serve me well as an intern, where my life will be filled by to-do lists, check boxes, and (somewhat) predefined tasks. in the past couple weeks, i have felt satisfied at checking off many (large) boxes centered around finishing up requirements for 4th year, applying for internal medicine residencies, and living life. presented in classic sign-out form, here are the highlights for you below:

Work:
[X] Step 2 (my last test of M4 year!)
[X] ERAS (Electronic Residency Application)
[X] Letters of recommendation for ERAS x 2
[X] Dean's letter appt and review (this letter sums up how you did in med school & talks about how cool you are)
[X] Internal medicine appt with Dr. Grum (for the Department letter, since i'm applying in medicine)
[X] CCMU (Critical Care Medicine Unit, or the MICU) - 2 calls down, 5 calls to go. I guess I really shouldn't really check off this box, but it feels good anyway, so I will, for right now.

Play (mostly):
[X] Celebrated our one year anniversary in Western Michigan. Chris and I stayed at a local B&B, ate some good food, and went shopping in Holland. We also got fabulous peach pie from Crane's Pie Pantry in Fennville.
[X] AMSA COC (Chapter Officers Conference). Lots of QT here with my some of my fave AMSA peeps, including Catherine Jones, Dan Murphy, Andrea Knittel, and Rishi Rattan. I also got to visit with Jay Bhatt.
[X] Hanging out with some fellow M5's, M3's, interns, and residents. It's been awesome to meet new people at different levels in the hospital and hang out with them on the outside. (I'm not sure Chris is as thrilled about this new development, but he humors me anyway. I appreciate it!)

Random fun stuff:

[X] I was found by Cooper, an organizer at Blogher, online. She contacted me about BlogHers Act!, an initiative you can read more about here. Women bloggers from all over voted on global health as an issue they want to tackle this year, and cooper asked me to speak at the unveiling of this way exciting topic. Unfortunately, it was the weekend before Step 2, so I couldn't, but I wrote a letter that she read to the assembled bloghers at their national conference. Fun!

[X] Kevin, a former GHAC chair, nominated me to be profiled at this upcoming exhibit at the Ntl Library of Medicine on leaders in global health. I'm still filling out written interview questions for this thing, but I did a phone interview where I talked about AMSA, Thailand stuff, and organizing. The exhibit goes up next spring/summer and will also have an online component. Hopefully, I can convince other people to get involved. It's also humbling (and heartwarming) to have people you work with respect what you do (and think about you when things like this come up.)

Enough signout for now. I've been a slacker about updating, and it's hard to get back into the groove of blogging, so I thought I'd start with what I do best - a checklist. All you intern readers out there - hope you enjoyed :)

NB- For all you non-med people out there, 'sign out' is something you have to do when you leave the hospital everyday if you're on an inpatient service. This consists of a blurb on your patient(s), why they came in, what you've done for them in the hospital, and then a list with little boxes (as above) for things you need your cross-covering intern (the intern on call) to do while you're gone. This usually consists of checking labs or following up on (specialty service) consults you have put in on your patient for a specific problem they might have. It also has fun tidbits on how to handle certain situations should the nurse call in the middle of the night. For example, one of my patients had this on her signout:

Note: Patient's BP falls to the 80's when she sleeps. If this happens and people are concerned, wake her up. Her BP will return to normal.

a day at the va spa

2007-07-14T14:04:00.000-04:00

my attending went away for the weekend and so the chief of ID at the Ann Arbor VA covered for her yesterday. the chief of id is my kinda pseudo-advisor and i had some email conversations with her while i was still on my fogarty in Thailand and then later talked to her in person at the VA. she is hugely famous and is one of the world's most foremost experts on fungal and yeast infections. for medical people out there, let's just say that when i went to read about a patient i had with Candida parapsilosis, Dr. K. was the author of the Up-to-Date article "Overview of yeast infections." i was trying to explain how crazy that is to Chris, to have your attending be the primary author on numerous Up-To-Date articles in the field that you're hopefully going to go into. anyway, she's a big deal, but really down-to-earth and into teaching and giving good advice. basically, she would be a woman version of a nice dr. cox (on scrubs) but dr. kelso's age. i just got the feeling that that was a terrible analogy, but im free-writing, so i'm going to keep it anyway.

in any case, yesterday was pretty slow. i got one consult for a patient who had Bacteroides fragilis growing out of his blood cultures but E. coli in his urine, and we were asked about the source of his infection and on recommendations for treatment. i learned a lot with my senior resident (who was also interested) and hopefully made a good impression. i was surprised that i i didnt feel as intimidated as i thought i would and also was psyched to learn a few things on rounds, which always includes a trip to the microbiology lab, where i smelled some S. mutans on a plate. There was a vote on whether the S.mutans smelled like butterscotch or butter popcorn and I voted for popcorn (it ended up being a tie). who knew micro lab could be so fun?

later, we went to change a dressing on a wound. i went to help get supplies and had tape to keep the dressing in place (which i can never tear). dr. k. watched me struggle with the tape briefly and then took it from me and ripped a piece off without a problem. her advice to me: "you have to be bold!" the patient's wife (who was learning how to do the dressing) interjected that she always had a problem with the sticky tape so i didn't feel so bad. granted, i still am decades younger than either party though. note to self: practice tape-ripping skills for further ID work.

after rounds, i went to work on my note. during that time, i got excited since i received an email from an administrator at Johns Hopkins saying that the Fogarty International Center funds from their center would pay for me to go back and spend a month at Dr. Cynthia's clinic in Mae Sot, on the Thai-Burmese border. this means that i will return to Thailand twice this year, once as a OC Hubert/CDC Foundation scholar and once with Fogarty. I'll be spending about a month in Thailand each time and be based in two different places (Nonthaburi, outside Bangkok, for the CDC, and Mae Sot/Chiang Mai for the Fogarty). Maybe fourth year will turn out to be more like my "year off" than I originally thought. :)

in any case, this email got me really excited. when i went to leave for the day, i stopped by Dr. K's office and told her about it and the projects i was going to be working on in thailand. we talked about how medical education was changing at michigan (some medico-legal officer doesnt think student notes should be allowed in the medical record anymore?!) & the differences between thailand and the us. i brought up that the Fogarty Center had solicited a piece about "the need for patient education and health literacy in the health care system, drawing from your experiences in Northern Thailand" after reading my article in The New Physician. i was kinda offended although i'm not totally sure why, but i feel defensive about people just being like "can you comment on the plight of the poor?" or the sentiment of "please draw from your exotic experience and perspective as a first-world person working in the third world." it's not like people in the US don't need health literacy too, although i don't think the woman who emailed me was implying that they didn't.

i ended up writing the article, which i posted on my friend's health-care related blog, cure this!. it will also be published in the July issue of Global Health Matters (the Fogarty newsletter), but decided to compare my experiences in the US and Thai health care systems instead of just focusing on Thailand's shortcomings. Dr. K. and I talked about this for awhile, and i was really struck by a comment she made when I noted that my close friend (and ID fellow) would see a ton of patients in clinic and not really have a ton of time to talk to them or write the best ever notes in the chart, but she was still providing good medical care. Dr. K corrected me - "excellent medical care" and noted that Thailand's health care system may not be perfect, but the docs over there were truly saving lives.

as i prepared to leave, she said that she was excited for me to return to Thailand and advised me to take malaria prophylaxis, adding, "You should go back - it's a privilege to be in a place where you can really practice medicine."

i sometimes wonder if mentors know how much students look up to them, and how a little comment can really go a long way.

i am an immigrant in a country of immigrants

2007-07-09T21:19:00.001-04:00

i started id consults today. besides myself, my team consists of another 4th year med student who was originally in my class, a third-year in her last month of internal medicine residency, a fellow from Romania, and the attending. dr kauffman introduced me to my attending (dr malani) last month and i met with her to talk about possible research projects a few weeks ago. besides having a common interest in id, we also discovered that i lived in the house across the street from her childhood home until i was eight years old. the world is small, and the island i grew up on is even smaller. in any case, we decided that i was going to work on writing a review of HIV care in the elderly patient with her and another fellow & plan on publishing it in a geriatric journal. im super excited about it and think ill learn a lot! yay for side projects :)

back to id consults and my team. i think the first couple days on a team are always interesting because you're getting to know people because you're sitting in small rooms with them. of course you're talking about patients part of the time, but (if you have social skills) you're probably talking about life-outside-the-hospital for most of the other time while writing notes, waiting for phone calls, or just doing busy work. as a team of almost all women, the subject of families (and children) inevitably came up early on. all of us are married except the guy on my team, so we talked about husbands and husband's jobs and whatnot. i also found out that my resident went to a liberal arts college and did post-bac at bryn mawr (yay tri-co). she noted that she thought we (as michigan med students) had to work way harder (and learned more) than she did during med school but that it probably didnt matter in the long run. i told this to post-call liz today and she confirmed the widely-believed rumor that michigan med does totally prepare you for internship, so at least i know the q4 is worth it :).

in the afternoon, i got a chance to bond with the fellow who just started at u of m last week. she is originally from romania, where she completed medical school and trained in id. she admitted she was nervous about starting (arent we all, regardless of what stage of training we find ourselves at at any moment in time). we talked about our backgrounds. she talked about moving to america six years ago when her father was approved for a green card and the decision on whether to leave her career and her husband's career (as well as their homeland and life) behind. in the end, they decided to try it for their children who were six and two at the time. she vividly remembers taking her son to first grade in october, when they arrived in america. he did not speak a word of english, and the first day of school he asked his mom "what should i do if i have to go to the bathroom?" talk about resourcefulness and resilience. when she told this story, she was proud of him and proud of his struggles. they all struggled at the beginning, working jobs that paid less than $8 an hr - a big change from their professional lives back at home. eventually, she started studying, got into a residency, and matched into id at u of m. her eyes lit up when she talked about it, saying that she suffered from a lot of inferiority issues as a international medical graduate, didn't think she would get in to an IM residency in the US, much less fellowship. getting into michigan was a "cherry on the top", in her own words. i felt privileged to hear her story and to work with her. it reminded me of how lucky i am to be educated in this country and of the opportunities i have. she also gave me the opportunity to share my story with her.

i am second generation thai-american. i am the daughter of immigrants. i grew up in an almost exclusively white neighborhood on an island and was one of two or three asians in my graduating class.

i wanted to be white for a long time (i didn't really talk about this part with my fellow though). i was frustrated that my parents had rules that my friends didn't, like family dinner everyday with no tv and talking about everyone's lives. i had the same curfew from 9th grade-12th grade until i threw a fit my senior year and got it extended to 1 am (but if i was out, i still had to call to check in). even now, as a married woman and almost-doctor, i still try to call my parents everyday.

identity was a hard thing for me to figure out and was definitely a learning and growing process throughout my young adult life. my parents were always supportive and adamant about being not-american (which they equated with being white). sometimes, it was okay to be american because it was good to blend in and win at their games (academic ones, of course). i distinctly remember my mom saying, 'if another kid in your class gets 95%, you have to do better than that because you are asian (and your work won't count as much).' she thought it was also important that we were able to succeed in an all-white environment since she figured that was what our workplace would look like in the future. interesting message, but one that stuck with me for a long time - fit in, but remember, we are not like them.

i spent a lot of my adolescence fighting with my parents who were raising me 'thai' which meant no going out after darkness and no boyfriends (for girls). obviously i rebelled against all these rules, but i have to give it to my parents for trying. in retrospect, i can say it was okay to be raised 'thai' (and many thai people, including all the nurses i worked with at the repro health clinic in Chiang Mai, approved).

as an adult (it's weird that i am no longer considered to be in the 'youth' category, although 26 is the cusp), i am proud to be the daughter of immigrants. i think my parents demonstrated incredible strength and recognize their sacrifices to give us the lives that they didn't have. i think it is super awesome to come from two worlds, to be thai, to be asian, to be american. i feel like being the daughter of immigrants gives me an unique perspective on language, culture, and struggle. chris and i have talked about our children and how they will be third generation, and that i am sometimes sad that they will not be children of immigrants. i used to think that so much was lost from generation to generation, and sometimes i feel that is still true, but i think a lot is gained too. my parents wouldn't speak out or protest at a rally, but they do donate money to causes (like MSF, or Doctors Without Borders) that they think are cool. i do both, and i try to actively pursue social justice in my life and career (hopefully my kids do too!) with privilege comes a lot of power, and im trying my best to use my privilege to do good in the world. i think it's working so far :)

at my fellow said, 'i came here for my children - if they are ok, i will thank god and know that i made the right decision. i have no regrets." i said, "i think my parents feel the same way and i think your children will be good and make you proud." when i left, she said "thank you for sharing your experiences with me." i smiled and said, "thank YOU!" i think it is really brave for people to share their stories and be honest and admit to their insecurities with others, especially at the first meeting.

it was nice to have that conversation to set the tone for the month, and to remind myself that i do make my parents proud in both traditional (yay my kid is going to be a doctor and my life is complete!) and non-traditional (what is this social justice you're always talking about?) ways. i tried to re-enact this whole conversation with my mom tonight (in the middle of writing this blog entry) but she was watching a korean soap opera (i could hear the music in the background) so she didn't contribute much to the conversation. go figure.

US Social Forum and my identity politics

2007-07-02T08:42:00.000-04:00

a good friend and past amsa pres was supposed to speak at the US Social Forum in Atlanta about access to essential meds and pharmfree but couldnt make it at the last minute. i was chosen to go in his stead. i didnt really have any background about the US Social Forum at all and tried to hurriedly make plans to get myself down there and find a place to stay. it was pretty stressful. my last-minute ticket cost almost $500 and none of my friends or contacts could offer me a place to stay. i ended up splitting a hotel room downtown with a college student my age from DePaul in Chicago whose class was centered around the US Social Forum. The trip overall cost over $800 for me, but i was able to use my savvy fundraising skills and get most of it covered through IPHU & Global REACH at Michigan. i am thankful for those who support students to attend conferences like these because they really give you a chance to ground yourself in what you're doing. at the same time, my experiences at the USSF really pushed me to go beyond my limits in thinking about not only my identity as a woman of color, but also about the politics that inform my work and my life.

it has been a long time since i've been to a non-health related - or even non-academic -conference. although amsa is awesome and has really helped me provide me with a community of like-minded peers throughout my medical school experience, i was reminded in not-so-subtle ways during the USSF that being a future physician made me part of an elite community. i was no longer a 'college student' or a 'community organizer.' i was not 'youth'. sometimes, i was a representative of the 'broken health care system' or 'the medical establishment.' comments on the first day of the IPHU (International People's Health University) brought back vivid memories of me not feeling XXXXX enough in college. Not Asian enough, not poor enough, not radical enough. i felt frustrated because i didn't like the way i was being judged. i am working hard in the best ways i know how to fight for health care and social justice. med school has not been an easy road for me, but sometimes i need to be reminded that my life has been one of extreme privilege. i struggled with that fact in college for a long time. feeling guilty and not knowing how legitimate i could be in fights for social justice. discounting my parents' struggles because i was angry and felt like i didnt have any of my own to share. growing up and realizing how insulting that was to my parents who worked around the clock to give me all of those things that they never even knew existed in rural Thailand. appreciating them for sending me to Swarthmore, where i began defining social justice for myself, and being okay with bearing their hopes and dreams while still trying to figure out the ways in which i wanted to infuse and live my own life, but not totally ready to believe that my life was partially theirs too.

i remember a conversation i had with a friend, rafael, in college. i was in my i-will-not-go-to-med-school and my-parents-cant-make-me stage of my pre-med career, and he was really adamant about me taking agency and doing what i wanted with my own life. "Screw your parents!" he said. "It's your own life; you're the one living it!" "What would your parents do if you didn't do what they wanted? Disown you?" i had never thought of things to that extreme but just knew that i really felt guilty disappointing my parents in any way. i also felt like i had a big responsibility to prove to them that everything they had done for me was worth it (my mom was never hard-pressed to compare our family to others to prove how committed she was to us). looking back on my childhood (and even at my life now), i have to give it to them though. i had every lesson - ballet, TaeKwonDo, ice skating, roller skating, swimming, piano, and more - that my mom thought would make me a well-rounded person. i went to summer school or camp as soon as i was old enough. my parents' lives were consumed by working at their family practice to save up money for lessons, for school, for medical school. their dreams were a big thing to carry. sometimes, i think they still are, but ive learned many things over the years that have made it a little easier.

i had dinner with a friend and family physician, anjali, where we shared stories of our second-generation histories, stories of how our parents had shaped our lives and stories of how they could be the most supportive people in the world or how they could crush the fragile (independent) identity you thought you had built for yourself. anjali asked if my parents had been supportive of my 'years off' (particularly this last one). i think so, i said, but i prepped them for a long time so they knew it was coming. i have learned to use their language and to frame my decisions in terms of things they value and understand. in college, my parents valued getting into medical school, and now, they value getting into residency. i frame almost everything i do into these contexts and they're okay with it. i've also had a decent track record so far, so i think they've learned to trust me (although they were a little shaky about the whole majoring-in-Chinese thing and organizing in Philadephia's Chinatown in college). i often talk about karma with my parents as well. good karma through my actions is good karma for my parents. to me, it also means that im using my privilege to try and make a difference while i have the chance to do so. i wake up everyday and think about how lucky i am. i hope that i am living up to my past lives and my past karma as well, and pouring water and not salt into the mix. (see analogy from a Buddhist monk in the entry.)

back to identity politics. after being totally overwhelmed by the number of workshops offered at the USSF (about a hundred for each time slot), i decided to center my didactic experience around asian-american issues, attending workshops set up by NAPAWF (National APA Women's Forum) and CAAAV (Coalition Against Anti-Asian Violence). i contributed to the IPHU and to conversations about health care access by presenting about what is going on with Thailand and Abbott, but did not go to any other health-focused workshops after that. i heard amazing presentations from groups like the Asian Pacific Environmental Network, the Bus Riders Union, DRUM (Desis Rising Up and Moving), the Chinese Progressive Alliance, and the API Women and Family Safety Center. i participated in discussions about trafficking, heard stories from workers in sweatshops, and was excited to see and be around tons of progressive APA youth. i felt the need to move to california to be a part of these movements, this organizing. i remembered what it felt like to be comfortable in a room where everyone looked like me. i realized that my days of asian-american organizing were not over, that it was silly to think that i had grown up and moved beyond identity politics because i had already figured out how to be proud of being Asian-American. i finally thought about immigration and diversity and about a lot of things that were coming down around me and how this connected to our struggle as a people and to many other struggles as well. i remembered the moments i had become excited about going to medical school when i saw that health care was a basic right that people needed and i thought that as a doctor (like Dr Siu in Philadelphia) i could provide that. not having health care came up over and over again when people were sharing their stories. all of this resonated with me, and a part of me came alive again.

throughout the four days i spent in Atlanta, i had long conversations with people i cared about and met some new friends as well. i thought about priorities, about what i want out of a residency program, about what kind of community i want to be a part of and how i could build that. i shared my perspectives and my stories and made commitments to help people process where they were going and what they were doing whenever i could. i was happy to come home and didn't feel guilty about it. i thought a lot about how i could be a part of the asian-american movement while being in the midwest. i thought about how, when one of the organizers of the workshop got people to stand up in groups and cheer when he called out where they were from, he didn't know to call out after saying "California" and "NYC" and how the Midwest and South and Northeast just all got lumped together. i briefly felt not Asian enough, but then thought about the necessity of representing my own community that was not based in LA or the Bay Area. i reminded myself not to be ashamed of being, as F.Omar Telan refers to himself as, suburban fabulous.

i briefly shared some of my thoughts with chris when i got home pretty late at night and tried (unsuccessfully) to re-enact the CAAAV workshop with all the different speakers sharing their stories in different Asian languages. before we went to bed, i told chris that i maybe wanted to move to california. he smiled.

june meeting

2007-06-24T12:50:00.000-04:00

amsa june meeting has been a part of my life since M1 year. it's basically a big meeting where most everyone on national leadership (board of trustees and action committees) get together and plan the rest of the year. it's also a space to be inspired, rejuvenated, and to love and be loved for your work and your commitment to health justice. my amsa friends have definitely been some of my closest friends over the past four years and it's been great to have a national network/family behind you.

this is the first year i've been a chair (or project manager, as it's known in corporate america) on the action committee side of things. this means that i make sure work gets done among my five coordinators (all fab, of course!), offer support to them and others in national leadership throughout the year on issues of policy & programming, and represent GHAC at-large on the AC Executive Committee. it's a big job, and i'm happy to fill it, although i did waver back and forth on whether to run from abroad quite a bit. (thanks to chris for listening to me do this and continuing to bear the brunt of my vacillation on all things AMSA). overall, i LOVE AMSA and think it's really super awesome, but sometimes it's difficult to keep things in perspective while also being a fourth year med student, wife, daughter, and friend, among other things.

june meeting was AMAZING in a lot of ways. i finally got to meet my committee and run my first meeting as ghac chair. i think i did the best job i could, but know there's a lot of room for improvement, and really need to work on following-up with people to make sure deadlines get met. the best thing about committee time is that i think that our committee really bonded together and that we gained an appreciation for each other not just as friends, but also as activists. ghac continues to grow bigger and better as the years go on, and i'm very excited to be a part of the energy with a brand new group of coordinators as we start off another academic year. i feel like i have so much to learn from each person on my committee and that i'm very inspired and excited to support them in all their work this year. being a chair is also a great chance to reflect on my experiences within AMSA leadership, and i was reminded even more of this when i looked over my speech to run for chair, which i've cut and pasted below for those of you who weren't at national convention this past year:

Hi everyone! Thanks for coming to GHAC org time, whether it’s to run for a national position, support a friend that’s running, or just to check things out. I really appreciate all of you being here, especially since it’s near the end of conference, and you all must be exhausted from speakers, workshops, meeting new people, and hopefully, being inspired by fellow students and activists. I’m really sad that I can’t be there in person today (this is the first conference I haven’t been to since 2004!), but my thoughts are all with you from Chiang Mai, Thailand. If you haven’t noticed yet, being part of GHAC usually means you have friends to visit in cool places.

My name is Tanya Wansom and I attended my first national conference three years ago, ran for the HIV/AIDS coordinator position, and never looked back. I’ve been involved with GHAC for the past three years as a coordinator for two years and an editor for Global Pulse this past year. AMSA has given me a lot of opportunities to grow – as a leader, an activist, and a community organizer – and I’m excited at the prospect of running for GHAC Chair, where I can support the future generation of AMSA leadership using my past national experience and also make sure that the general membership keeps getting more involved.

As chair, my main duties are to support my coordinators, represent GHAC to the larger national AMSA leadership (including the president, Board of Trustees, and other AC committees), and make sure the general membership at large knows what’s going on and how to get involved. I’d like to bring back general GHAC monthly newsletters on the listserv and look into starting an AMSA GHAC blog where everyone can post articles on different topics and activities that are going on in different regions. Also, I’d focus on institutionalizing many of the liaison positions we have with other professional global health organizations (and expanding them) to make sure there were more opportunities for students to study, work, and find mentors abroad. Most importantly, I’m happy to hear about what you – as a GHAC member – would like to see GHAC working on or doing in the coming year.

GHAC has, and will continue to be, a powerhouse in AMSA. I hope you give me the opportunity, as chair, to build on the work that so many people have contributed to over the years. Thank you.

AMSA has definitely been one of the defining experiences of my medical school career. I'm especially happy to serve on AC Exec with many friends from over the years, including some of us who had taken a year off (Catherine Jones, Community & Public Health Chair & Vishad Sukul, Humanistic Med Chair). Michigan Med also has an amazingly strong presence this year on AC Exec with three members on the board (me, Michelle Debbink, HPAC Chair, and Andrea, LGBT CHair). Andrea and I had the opportunity to get to know each other *a lot* better after spending five hours waiting for a flight together, which ended up getting delayed to the next morning due to 1) a tornado and 2) a computer glitch that shut down everything on the East Coast. andrea and i also roomed together with Catherine and Laura (also on LGBT HAC) and affectionately named our room the 'lame-o' room as we are all not so into partying, drinking, and staying up really late (although we inevitably do anyway). we are into changing into our pajamas really early, trying to go to bed early, and waking up early to eat breakfast (hence the lame-o term).

anyway, besides being a lame-o at amsa meeting & riding the grandma bus home early after actually going out to washington, dc, i was really happy to meet new AMSA peeps and reconnect with old ones. i really like the group of people im working with on AC Exec this year and feel loved and supported by most of them. i also got to see some of my old fave peoples (albeit briefly) at June meeting including Casey (RT), Davekumar, and Kevin Burns. being back into the AMSA swing of things has helped me readjust to my life back in the US and given me a place to channel a lot of my energy and enthusiasm for the year. it's also been a source of some (good and bad) stress, namely in the forms of trying to set up basecamp (this online networking tool) for my committee and also as a last-minute invite to speak at the US Social Forum in Atlanta this coming up week. I'm totally honored to be asked to be one of the AMSA reps at the USSF, but it was really stressful to buy a ticket, find a hotel room at the last minute, etc. In any case, I'm excited to participate in the International People's Health University, a four-day short course on health justice and organizing, and to speak at an Access to Medicines panel at the conference itself. I will also be meeting up with fabulous AMSA peeps Dan Murphy (now the legislative affairs director), Anjali Taneja, Kevin Burns, and Catherine Jones. Hopefully I won't have as many problems getting to Atlanta as I did going to Philly & DC on earlier trips this month.

ups and downs

2007-06-24T09:13:00.000-04:00

since my sub-i has ended and i've been on a 'vacation' month (meaning im not registered for any rotation at my school), i've felt like i've really run the gamut of emotions since i've actually had time to think about being back in the US, process a little about Thailand, and get used to my role(s) as daughter, medical student, sister, and friend again. nothing too extreme, though. my life has definitely been in a lot of flux lately - starting fourth year with a different class, sending many of my friends off to different areas of the country, and figuring out what my responsibilities are (and what i want them to be) regarding the million-and-one extracurricular activities that i have gotten myself into over the past four years. a lot of times these activities - especially AMSA - are the ones that have kept me sustained and focused throughout my medical school career, bu they can also be the source of stress, frustration, and the feeling that i've gotten myself into deep.

my year off was good to give me a sense of perspective. i didn't keep that perspective for too long though and jumped back into a VA sub-i, where i was kept busy for most of the hours of that one month rotation. when it ended, i realized i had a lot more free time (which was supposed to be used for Step 2 studying), but ended up being devoted to what i affectionately refer to as 'life maintenance' instead. don't get me wrong - im definitely studying for step 2 - but im also traveling A LOT (more than i would like). during the month of june, i will have been to Philadelphia, Washington, DC, and Atlanta, all on separate trips. more on each trip below:

1) Philadelphia. i attempted to go to my five-year college reunion at Swarthmore with Chris almost immediately after i got off last call at the va. our flight ended up being delayed a few hours due to weather on the East Coast and then cancelled altogether. chris got a flight attendant to schedule us on a direct flight for the next day (Saturday) arriving at 3 pm. i was exhausted and frustrated with the whole ordeal and really wanted to eat breakfast at one of our fave ann arbor spots, northside grill, the next morning. we ate there and then hustled to the airport to catch our flight. in the airport parking lot, i (finally) noticed that i had accidentally left my purse at the restaurant and did not have any id. we tried to call my brother to have him pick up the purse to no avail. chris was less-than-happy and tried to go talk to an agent about getting on another flight. i felt like maybe it wasnt meant to be and we shouldnt go at all.

the agent said i could fly without an id (you just had to go through secondary screening). i was stuck in secondary screening for awhile and had to run to the gate. i almost missed my flight to philadelphia (where i had been upgraded to first class). this whole incident reminded me of the first time i met chris (less the id part) since it involved running in an airport, chris arguing with a flight agent, and us sitting on opposite ends of the plane.

the swarthmore reunion was okay but i had missed 90% of the events for the weekend and we ended up not being in the philly area for very long - a little over 24 hours. a lot of my friends from swarthmore that i haven't seen since graduation also were not able to make it. however, i did get to hang out with some of my favorite people from tri-co, had a little reunion with people in medicine from my class, and spent some QT with bryan. highlights of the weekend included:

-just being on campus again and being super jealous of the new science center and wondering what happened to parrish (nice student lounge, though!)
-eating a huge bowl of pho for $4.95 at xe lua in philadelphia's chinatown
-breakfast at java joe's in woodlyn
-buying more swarthmore paraphernalia (chris even got a swarthmore t-shirt...the swat fever is taking over :) )
-meeting geoff semenuk, the associate director of alumni relations, who ive been chatting with online for the past month or so. he introduced me to some cool alum who are at the CDC that gave me interesting advice/perspectives about different ways to pursue public health careers.
-catching up with some of my old bio profs
-walking in the crum woods with chris
-a wawa sub and lemonade-iced tea
-king of prussia shopping spree

overall, a good weekend, but a little disappointing in terms of timing, not being able to see all my friends, and wishing i couldve spent more time in philadelphia.

next trip - AMSA june meeting, reston, va. (im doing this as a separate post because i think things will get wayyy too long).

va sub-i and the fun of fourth year

2007-05-29T11:06:00.000-04:00

so, if you're one of my loyal readers (and a former/current med student), you probably remember me being a *little* freaked out about starting back on the wards on a VA medicine sub-i. you may even wonder if i have survived this sub-i month, considering i fell off the face of the earth, am no longer allowed to obsessively IM people (the VA blocks a lot of sites!), and haven't updated. of course, the month is going great (like everyone said it would); i survived my first day back on call (also my first day of 4th year), and have become a pro at CPRS (the VA computer system) in no time. i'm confident about my ability to take care of patients, generally admit 2 patients every call night (we take q4 with the interns), and follow-up on their issues with a daily note and orders until they're discharged. i still think it's going to be crazy to take care of 9 patients all at once as an intern, but so far am doing fine with three. i've remembered a lot more than i thought i would, and actually am looking forward to have everything come together and hardcore study for step 2 to get it over with.

i have to say, it is GREAT to be a fourth year. the interns and attending treat me as part of the team, i don't have to round on the entire census, and im more in the loop regarding what's going on with my patients since i take more responsibility for their care (ie getting studies done, etc). i also feel like im contributing to the team because the interns have to take one or two less patients on call (although it may be more work for the senior). she's been awesome though (AND she's going into ID) so it's been good times.

i'm always really lucky when it comes to teams (knock on wood) and this one was no different. our interns switched last week, but my first two were great, really supportive, and gave me some tips on the interview trail and their impressions of different programs. we celebrated the end of their va month with a trip to dominick's post call. the cashier at dominick's was kinda funny when he was taking our order and said he hoped we weren't going back to the hospital to save lives after downing our order in dirty scrubs. no worries - after i drank both beer and sangria and didn't eat lunch, i promptly fell asleep when i got back home (waking up with a hangover four hours later). fun times post-call.

speaking of post-call, my schedule has also worked out surprisingly well for making graduation parties, bbq's, and other fun gatherings my friends have planned before many of them leave ann arbor for good. so far, i've attended Emily's graduation party at Al-Ameer, Lori's graduation party at Andiamo's, Susie's Memorial Day BBQ, and more - all post-call! the highlight of susie's bbq/bonfire (held saturday night) was definitely getting to meet little Noah, who is almost walking at seven months and just a really happy baby. i've decided that maybe i do like kids a little more than i thought, and i'm looking forward to the day chris and i have our own, although that shouldn't be for a couple of years (the fortune teller in Bangkok said we *could* have an accident this year, but we're doing all we can to make sure that DOESNT happen).

back to the va. the new interns on our team are super nice, and i know one of them from AMSA days, so it's been nice to catch up. we had a super slow call day over Memorial Day Weekend (i got my first - and only - admission of the night at 10:30 pm) and i got a chance to bond with my team, tell the story of how chris and i met, listen to the story of how other people met their partners, and get advice on 4th year/residencies/etc. ive been really happy with all my medicine experiences at michigan and am strongly considering staying for residency, but will definitely try to interview broadly and see what's out there. my parents (esp my mom) are of course thrilled about this and i'd definitely be happy about staying close to home, esp for when we are thinking about having kids. as always, chris is super supportive about my career and although i think he would be happy going back to cali, he would also be really happy not having to move and pay a million dollars in rent every month. we'll see how he likes his first year at his new job and what he's thinking about re: grad school, but it would definitely be awesome if he did his MBA at michigan. it IS great to be a michigan wolverine - we're excited about getting partner football tix for this season after not having them since M1 year. bring on the tailgates :)

pentwater!

2007-05-15T18:12:00.000-04:00

note: i never finished this entry but i decided just to post it now anyway because it's long overdue. next entry: update on va sub-i, which is more than halfway over (only 3 calls left to go!)

after a blissful, relaxing weekend in pentwater at the eaman house, i returned to ann arbor for a few days and hit up the Class of 2007's graduation before starting my internal medicine sub-i at the VA yesterday. im post-call as i write this, so y'all are going to have to bear with me, but i wanted to get some stuff down before i got wayyy behind in my blogging life.

pentwater was really good and the first time (in four years!) that suhani, liz, and i really just ran away from all our responsibilities and devoted 24-7 to hanging out with each other. all of us were super lazy, but we filled our days browsing the few open shops downtown, eating, napping, eating more, watching scrubs and america's funniest home videos, and going to the beach. the most strenuous activity i engaged in during our 2.5 day stay in pentwater was climbing 'Mt Baldy', or a seriously tall sand dune behind the Eaman house overlooking the beach (and Lake Michigan), which was more than enough exercise for me :)

on the way home from pentwater, we stopped in grand rapids to meet suhani's mom for lunch at noodles & company (suhani's mom kindly took all of us out!), admired phone pics of suhani's mom on a pimped-out harley davidson, and went on mad shopping sprees for graduation accessories at a local mall. it decided to pour intermittently all the way home but liz was a great driver and we all made it home safely.

home sweet home

2007-05-08T07:32:00.000-04:00

if any of you have been obsessively checking my blog to read about my safe return to the us, i apologize for being a slacker about updating. however, anyone who knows me really well also knows that i never plan on any downtime when coming back to the us and usually just throw myself into whatever commitments i have (ie med school orientation). this time was a little more relaxed, as i had 1.5 days in between getting back to ann arbor and getting on a plane to washington dulles airport for amsa exec, but im back on EST and back in action.

saying goodbyes in bangkok was not as difficult as it has been previously because both myself and all other parties involved (nan, krit, maddie, amalee, etc.) knew that i would be coming back sometime within the next year. that being said, there were no tears involved, although i did feel (as i was going through immigration) that a part of my life was coming to an end. in a previous conversation with sural, a friend who is going abroad to lima, peru, this upcoming year (yay fogarty!), she asked me about the impact this year abroad has had on my life. both sural and i had spent a year abroad in between college and med school and now were also taking a break between M3 and M4 year to go abroad again. my reflections on the difference between the two were that as a recent college grad, i felt the whole world was open to me and i didn't have any great expectations about the work i would accomplish or the difference i would make on the world (although i did care about the impact my actions had on other people). i was more concerned about finding a direction for myself, learning about what it was like to live (and work) abroad, get in touch with my thai roots and build relationships with family, and just experience and try to get my head around what things like 'HIV/AIDS', 'commercial sex work', and 'IV drug use' really meant in people's lives and lived experiences. my fulbright year was defining for me because it gave me a direction and a purpose, and helped me define what my priorities would be in my medical school career. it also helped me put things in perspective while i was struggling through my preclinical years at michigan, not feeling really smart enough and not doing really as well as i would have liked, and gave me a place to come back to, not just emotionally and mentally, but also physically as well.

the past year was not as life-shattering or ground-breaking for me in terms of figuring out what i wanted to do with my life but it was valuable in a lot of other ways. whereas previously i had felt that the whole world was open to me (and sometimes i still do), i have recognized that being a physician gives me unique power (and means of) contributing to a larger fight for social justice. although im not saying that being a physician restricts me in any way, i think it does circumscribe the areas in which i can effectively (and knowledgably) make a difference. it took me a long time to realize this, and i struggled with the question while at the WHO in Geneva a lot, but i think it's nice to realize that you can't do everything for everyone (or even for yourself) and that's totally fine. this year helped me to define how i want to contribute as a physician (or public health practitioner), what i want my career to look like, and helped me identify what areas i needed to address to help me achieve my goals (anyone want to teach me stats?). personally, a year off (and abroad!) also gave chris and i the opportunity to explore what it would be like to live abroad together, and grow as a married couple. i now have a more defined direction regarding what i want to get out of training (and what i want to do with my training when im actually finished), and chris and i have a stronger relationship and foundation as husband and wife (i don't feel so weird saying husband anymore!) :).

in any case, i was thrilled to be done with the ridiculously long plane ride back to the US. both flights were packed and i had no layover in tokyo (i seriously ran off the plane, went through security, and then boarded the tokyo-detroit flight). i also had the pleasure of sitting in a section where the air hostess was unbelievably rude (esp to people who didn't speak english as a first language, where she became increasingly loud and rude when people didnt understand her questions such as 'chicken or beef') and wouldn't clear the trays of this chinese couple sitting next to me for over an hour. service on american airlines is really ridiculously bad (maybe ive been spoiled by living in thailand for the past year, but UGH!!). ok, enough about the plane ride. it took me a long time to get my baggage and clear customs in detroit (thank god they didn't send me to inspect my bags) and chris came to pick me up. i ate a bellacino's grinder for lunch on the way back home to Grosse Ile, which took an inordinately long time since it was the first day that the free bridge closed for repairs. still being incredibly jetlagged, i took a nap at home, played with dogs, and ate dinner with my parents (but i wasn't hungry, so i didn't really eat). this came back to bite me later on in the night, when i dragged chris to denny's for buffalo chicken strips because i was starving. all in all, a standard day back at home in michigan.

the next day, chris and i went to northside grill for breakfast (yummy!!); i ran into some med school classmates, and we went shopping for our celebratory BBQ at costco and meijer. we also stopped briefly at briarwood and i bought some lancome foundation for an awesome free gift (i think i may try to wear some makeup like p'noi taught me at red earth in bangkok) and then we went home to get ready for the bbq. as usual, it was a never-ending potluck, and i had fun catching up with many friends that i hadnt seen for a year or so. i did feel kinda time-warpy in a a way though as many people are moving on (graduation, residency, etc) and i felt like i had missed a lot of the big milestones of the year (like match day!). it's all good though, and i feel like i'll have a harder time adjusting when many of my friends, like liz and suhani, move away for real in the coming weeks. highlights of the bbq were eating lots of american food, chris being proud of himself for grilling some kickass organic beef hamburgers and hot dogs, watching grey's anatomy and scrubs, and feeling at home again (and enjoying the space!!).

post-bbq, i had to pack and get ready to go off to amsa exec in reston, va. this year, i am the global health action committee (or GHAC) chair, and serve on the AMSA Action Committee Exec Committee with seven other action committee chairs, the Action Committee Trustee, and the Director of Student Programming (all med students). i arrived friday afternoon, hung out with some SOS (student office staff), met with Pete from The New Physician about my piece i submitted to 'Letters from Afield', and then went to dinner at Chris's cousins' house in Maryland. it still never ceases to amaze me at how good chris is with kids (he played with karen, lucas, and matthew, ages 6-9, for hours) and i know he'll be an awesome dad!

saturday and sunday were jam-packed (as usual) with agendas, meetings, discussions, and the like. what's really exciting is that many of us have taken a break from amsa and have returned as chairs, and that there's also new leadership (and action committees) in the house. i was particularly excited to see catherine jones, the community and public health action chair from tulane, who i interviewed for this piece in Global Pulse about doing work post-Katrina, but really felt thrilled to meet new friends and colleagues and catch up wtih old ones. i got some terrific hugs (and welcomes) from people which i've missed while being away (hugs, especially between the sexes, are not so common in Thailand). i also discussed the use of public space (and trying to get used to strip malls ad nauseaum) with cjones, sadly ate dinner at an overpriced thai/chinese restaurant, and happily went to bed early with many other 'lame' ac exec members who like to stay in. thanks to everyone who made it a memorable weekend - i do feel energized and excited about amsa again, and am happy that i started my time back in the US in a place where i feel like i'm part of a family and a movement that helps me contribute (and achieve) things i believe in.

i am currently writing this from liz's dad's house in pentwater, michigan, where i'm spending a few days with liz and suhani before graduation (this friday!) and the beginning of my sub-i at the VA (may 14th!). i love weekends (or pseudo-weekends, like this one) in western michigan, and will write more about our fun adventures and relaxation here once i get pictures from liz and suhani. yay being back!!

goodbye, chiang mai

2007-04-28T19:24:00.000-04:00

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

2007-04-28T00:02:00.000-04:00

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

2007-04-23T10:53:00.000-04:00

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

2007-04-22T08:49:00.000-04:00

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!

2007-04-18T07:40:00.000-04:00

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!

2007-04-14T21:46:00.000-04:00

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!

2007-04-07T22:18:00.000-04:00

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)

2007-04-04T20:39:00.000-04:00

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!

luang prabang part deux

2007-03-31T03:19:00.000-04:00

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

2007-03-27T20:14:00.000-04:00

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

2007-03-22T23:58:00.000-04:00

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

2007-03-14T04:48:00.000-04:00

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

2007-03-08T10:31:00.000-05:00

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

2007-03-03T20:48:00.000-05:00

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

2007-03-01T22:38:00.000-05:00

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

2007-03-01T10:53:00.000-05:00

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!

2007-03-01T10:47:00.000-05:00

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?

fun with friends in february

2007-02-15T01:38:00.000-05:00

after dropping liz off to the airport, i returned to our studio feeling that it was strangely empty and quiet. we have been living in quite close quarters the past ten days, and i haven't really had a moment alone, so it's easy to forget what it's like to be by yourself. it reminds me of college when people are moving out but you're still around, or after honors exams at swarthmore and not having ANY assignments to do.

liz has been *much* better about blogging through her thailand adventures, but i have semi-good excuses (work, etc.) so i won't try to go into as much detail as she did over the past week, but will try to capture some of the highlights.

movies:
we watched lots of them. some i'd already seen before, but some were new. in the theater, we saw Final Score, a movie that followed a group of 11th grade guys at Suankulab School in Bangkok the year before graduation (also the year of entrance exams). It was funny, realistic, and actually really good! I enjoyed it and am very thankful that we don't have to take entrance exams (of this magnitude) in the States....and happy that other things besides test scores count.
other movies we watched in the past few weeks: thank you for smoking, talladega nights, ice age 2, nine lives, monster house, cars, the breakup, a winged migration, and this film is not yet rated.

movie-like shows:
simon cabaret (see liz's blog for this one). i think phuket's is better, but it was still fun. going with the transgender/transsexual theme, we also saw part of a drag show contest/charity fundraiser titled 'Miss Queen of Chiang Mai' for Valentine's Day at the Night Bazaar last night.

national parks:
Day trip with Gig to Doi Inthanon (we also stopped at Baan Tawai, a handicrafts market similar to JJ weekend market in Bangkok on the way). Doi Inthanon featured beautiful waterfalls, two matching chedis and gardens built for the King and Queen's 60th birthdays housing relics of the Buddha, and the highest point in Thailand.

Weekend camping trip with Gig and Aum to Jae Sorn National Park in Lampang. Along the way, we stopped at Carrefour, ate at the food court though (buy 200 B, get 300 B free on the weekends), and drove through Bo Sang, the umbrella making district of Thailand. The camping facilities at Jae Sorn were great and we were able to camp in an isolated spot near a stream filled with frogs and have essentially our own private bathrooms. Like many other northern national parks, Jae Sorn featured hot springs, and we were able to get the guard to open a large public bath for just the five of us after dark. The ladies also enjoyed an hour-long traditional Thai massage while the guys soft-boiled eggs in the hot springs and set up camp. Camp food featured the ever-popular ramen (Mama), kao tom (Thai rice porridge with pork), omelets, & fried chicken.

On the way back from Lampang, we spent a few hours at the Thai Elephant Conservation Center and Hospital (the only one of its kind in SE Asia). We arrived right after a show had started, so had to wait for the next one. Gig was unhappy because all the food in the center was overpriced (and not very yummy); we tried to pacify him (and ourselves) by eating ice cream after a disappointing meal. Highlights of this trip included watching a traditional elephant show featuring elephants helping people log, elephants bathing with the help of their mahouts (or elephant handlers), and feeding elephants sugar cane. Because we were there so early, we also got to hang out and watch elephants eat and do their thing while waiting in open stables. I read some USMLE Step 2 Secrets, but need to get back into the groove of studying again since I haven't touched it since then :).

Farang food:

Liz and I enjoyed a Valentine's day brunch at Pie Sabai, a small outdoor garden bistro that Ben introduced Chris and I too last month. We attended the monthly 'Ladies Lunch Brunch' which I found out about through Chiang Mai Expat online magazine and it ended up being a lot of fun. We were the youngest people there by at least a decade or more, with most of the ladies in attendance being of retirement age (or close to it). We had a great Italian themed-meal, enjoyed tropical fruit punch, and had interesting conversations with other Americans, including an art history emeritus professor and author who was a Smith grad. On the way home, we also stopped for a 99 baht hourlong foot massage outside Wat Umong and explored the temple grounds. It was the first time I've been there when there hasn't been anyone else in the tunnels, and it was very peaceful and calming. I still would like to check out the informal Dharma discussions they have there one of these days as well.

work:

i was finally able to meet up with poo again about the crypto project and we're going to begin data collection this weekend. lots of stuff is actually kicking into gear, and hopefully i'll be able to start data collection at planned parenthood as well. at the last minute, i also decided to submit an abstract to the 2007 American Public Health Association meeting on access to second-line medications and compulsory licensing for Kaletra (lopinavir/ritonavir) in Brazil and Thailand. exciting stuff, and i hope it gets accepted - it will definitely kick me into gear and help me finish a tangible product from my time at the WHO this past summer.

ive also been on an application kick lately, and finished two applications - one for an elective at Dr Cynthia's Mae Tao Clinic during my 4th year, and one for an HIV psychiatry elective for minority students run by the American Psychiatric Association. I'm really excited about both opportunities, and want to thank EVERYONE who helped look over all my statements!

I can't believe there's less than three months before I'm back in the US, see many of my friends graduate from med school, and start off my 4th year on a sub-i! For anyone who's interested, my schedule for next year (right now) looks like this:

May- Gen med VA sub-i
June - CCMU sub-i
July - Endo consults
August - Dr Cynthia clinic
Sept - HIV psych (if i get it), if not Community Psych
Oct - Cards
Nov- Contemporary Issues: Abortion
Dec- Vacation (and interviews!)
Jan - Advanced Therapeutics (yay online classes!)
Feb- Radiology
March- Henry Ford ER
April- Vacation!

Northern Thai food (aahan puen muang) and Talats (markets)

2007-02-08T00:42:00.000-05:00

Yesterday Aum called me around lunchtime and said, “Gig and I are on the way to pick you guys up for lunch!” I hadn’t showered yet because I was lazing around but quickly got it together and was happy I did, because they introduced us to another famous Northern Thai restaurant. The lunch crowd was large and we had to wait a little while for a table, but it was worth it! We got a ‘set meal’ with Vietnamese-style wraps (rice wrappers, starfruit, cucumber, garlic, pepper, peanut sauce), fish egg roll, betel leaf pork wrap, spicy sausage salad (yum moo yaw) and some other yumminess.

Following lunch, we stopped off at Warorot Market, the largest market in Chiang Mai selling food, dried goods, fruit, clothes, bags, and basically anything you might need. Chris and I were here a few weeks ago helping my parents locate dried longan and nam prik goong (shrimp paste). During that visit, we also tried fried silkworms, which people love here. Chris and I weren't impressed though, but at least we tried them. Food wasn't our priority today though and we explored a back street with small shops selling fabric, hill tribe crafts, clothing, and food. My find of the day - blue elephant pajamas! Chris’s find – an amazing Thai broom for 50 cents! Liz's find- two cute shirts (one with a girl who supposedly looks like me on it -we'll take a pic later and post for your comments!)

Aum had to rush home for her Bangkok Hospital English interview, so Gig, Chris, Liz and I stopped for Swensen’s ice cream at Kad Suan Kaew, the mall across the street from our apt. It’s strawberry season here, so there are special strawberry promotions featured there. Chris and I always get ‘Strawberry a la mode’, featuring bananas, strawberries, three scoops of ice cream, and warm chocolate that you pour over it. We will be sad when strawberry season is over because they’ll change their promotions L and also because fresh strawberries won’t be available on the street anymore.

The rest of the day was pretty lazy. Liz took a nap, and then I wasn’t feeling up to Simon Cabaret (we are going tonight!) so instead, we ate dinner at Pasta Café, one of our favorite spots in Chiang Mai and watched Cars on DVD.

I also was briefly really stressed out about my scheduling appointment for 4th year. Mostly, I was stressing over whether or not to do a sub-I first, since Liz thought that the clinical experience helped out for Step 2. In the end, I signed up for VA sub-I in May, so now my schedule for when I come back is likely going to be:

May - VA Gen Med sub
June - CCMU (Medical ICU) sub-i,
July - Endocrine consults and likely Step 2
August - Dr. Cynthia's Mae Tao Clinic

We'll see what happens in the end though!

temples and treks (in the old city)

2007-02-06T23:50:00.000-05:00

Yesterday we got an early start on the day with Liz frying up a breakfast storm (scrambled eggs, bacon, coffee). Chris took another Cisco voice-over IP test (three tests down, two to go!) in the morning while Liz and I lounged around waiting for him to come back. All of us then set off for the Old City.

We visited a number of temples and monuments in the Old City that Chris and I have never been to before, like the Three Kings Monument (showing King Mengrai, who founded Chiang Mai, consulting two other kings of different provinces in Thailand about the site of his new city). Liz and I are in front of the monument in the picture here. It’s funny how you live in a place for a long time but never go to any of the tourist stuff because you think there’ll always be another chance to visit that kind of thing and it’s not high on your priority list. Liz, armed with Let’s Go Thailand, was the impetus for us to get off our butts and move! You can visit her blog here.

One highlight of our daylong trip to the city included a visit to Wat Pan On, a temple next to AUA (where Chris takes Thai classes). We visited in the middle of the day and had a nice break on a part of the temple ground where they had a noodle cart and drink stand set up. I had Thai iced tea and Liz had water. She also captured this candid of us there:

In the temple, I introduced Liz to ‘siam sii’ or fortune telling. Originally derived from a Chinese practice, it entails shaking an open can of sticks with different numbers on them until one falls out. Once a stick falls out, you go to a shelf where you find your number and take the fortune corresponding to that number. My fortune (#16) was only written in Thai, so I had to have a friend read it later. It was a great fortune though, and corresponded with the fortune I had told to me by a local Thai fortune teller when I was just starting college in Swarthmore. The gist of the fortune was that I usually got what I wished for (ie if I put my mind to something, I was usually successful), was blessed with good health, and would have people who cared for me surround me throughout life. My sign, the sun, represents a bright future as well as how I bring warmth and happiness to those around me. Very good :) Maybe my projects will still work out after all.

Other highlights of the day included fish ball soup, an hour long Thai foot massage at the women’s prison in the city, vintage clothes shopping, and Thai dinner (and bread and chocolate!) with Aum and Gig. I also had this awesome online conversation with Gig and then we discussed weekend plans, so our trip to the mountains is coming together!

tanyaporn.wansom says: hello gig! how was pai?

gig_vitara says: hello. is ok.

gig_vitara says: we want travel with crist and porn,but ying and aum tell porn busy. my friend from bangkok.

tanyaporn.wansom says: gig! my friend from us is here

tanyaporn.wansom says: we want to travel too, this weekend?

gig_vitara says: Oh.ok

tanyaporn.wansom says: did you go to pai

tanyaporn.wansom says: last weekend?

gig_vitara says: yes 6 person.

tanyaporn.wansom says: oh :(

tanyaporn.wansom says: chris and porn never go to pai before

gig_vitara says: gig,aum,ying,pe,kea,maw

tanyaporn.wansom says: that sounds fun

tanyaporn.wansom says: you want to travel this weekend?

gig_vitara says: by car gig,

tanyaporn.wansom says: we can go however

gig_vitara says: gig tell aum,we want crist and porn with trip.

gig_vitara says: we can comeback again.

gig_vitara says: :)

tanyaporn.wansom says: go to pai again? or where

tanyaporn.wansom says: what you do later tonight

gig_vitara says: my friend from us.How many person?

tanyaporn.wansom says: 3 - porn, chris, liz

gig_vitara says: no plan.

gig_vitara says: ok.. we can travel.

Thai people are awesome hosts, so Gig helped us plan this cool weekend trip visiting a village in the valley of two mountains, the traditional Thai umbrella making factory (Bo Sang), an elephant camp and hospital, hot springs, waterfalls, and flowers. We’ll also spend the night in a tent at this campsite not too far(about 70 km) from Chiang Mai. Right now it’s just me, Chris, Gig, Aum, and Liz, but more people might be added from the MA house (we’d have to rent a van though, or take two cars). Thank God for friends with cars.

PS Liz taught me how to insert pictures in blogger with text wrap, so i added a few to previous entries - check them out!

reading list

2007-02-06T23:46:00.000-05:00

Since the winter holidays, I’ve been on a reading-for-fun kick. After I read Haruki Murakami’s latest short story collection and Gabriel Garcia Marquez’s novella mentioned in an earlier blog, I remembered how much I missed reading. Recently completed books include:

Midnight’s Children, Salman Rushdie
Fast Food Nation, Eric Schlosser
Middlesex, Jeffrey Eugenides

Next up, Kite Runner, which Liz just finished and is letting me read. :)

Attending the conference ‘Responding to Infectious Diseases on the Border Regions of South and Southeast Asia,’ where panels examined the different borders of Burma and also touched on important public health issues in the region. During the conference, I learned a lot about health, politics, and funding around Burma. I also took opportunity of the freely distributed literature there and consumed some papers and reports, including:

Licence (sic) to Rape: The Burmese military regime’s use of sexual violence in the ongoing war in Shan State
Chronic Emergency: Health and Human Rights in Eastern Burma, published by the BackPack Health Worker Team (a group of trained medics that was started by Dr. Cynthia Maung that goes into Burma to provide health care and collect public health indicators – fascinating stuff!)
Responding to AIDS, TB, Malaria, and Emerging Infectious Diseases in Burma: Dilemmas of Policy and Practice, published by my mentors Chris Beyrer and Vit S. (et al of course!) in PLoS Medicine in October 2006.

I also must admit my poor knowledge of geography was enriched when I found out India extended to Burma (I thought it ended with Bangladesh, but didn’t realize that there was a skinny part, kinda like an appendage moving eastward, going East). Another happy moment: I really like nagas, and was happy to hear that a province in India was called Nagaland (ok, maybe I’m a little lame, but it was exciting).

My parents also brought some Step 2 stuff, so I started reading Crush Step 2 & USMLE Step 2 Secrets. I’m hoping that I can take Step 2 early when I get back and then just do some sub-I’s and get residency apps out of the way before the fall.

Have you read a good book lately? If yes, let me know by posting a comment to this blog. :)

visitor-o-rama

2007-02-05T09:24:00.000-05:00

chris and i are in the midst of visitor-o-rama. we are :) about it though and it's really nice to see people that we haven't seen in a long time. here are some snapshots of our visits so far:

1) my parents. i havent seen my parents since i left the US in August! (weird for us since i see them almost every weekend when im in med school back at Michigan). they came to chiang mai for my dad's annual TPAA meeting (Thai Physicians Association of America) so they were pretty busy. while they were here, we helped my mom buy some thai dried foods at warorot market, hung out with them at their hotel, and ate some yummy chinese food with them. now they are in bangkok carousing with family and friends.

2) nan and mon. nan and mon were my two bridesmaids from bangkok. they came up to see the royal flora ratchapruek (this three-month-long international floral expo held in celebration of the Thai King's 60th Accession to the Throne) and we accompanied them there one day. ben, the other fogarty fellow, came along too!

Flower Show with Nan, Mon and Ben

our faves of the exhibition were the orchids (there were orchid competitions of natural gardens, creative gardens, individual plants, and a showcase of endangered/rare orchids) and Bug World.

mon left early, but nan stuck around and satisfied her craving for farang (foreigner) food. we took her to some of our favorite places in chiang mai, including 8 inch, a local thai pizza place where you can get your own personal pizza for 89 baht (a little over 2 USD). we also visited wat phra singh, and learned that it maybe wasn't such a good idea to ride all together (3 people) on our motorcycle.

Chris and I paying our respects to the Buddha

Wat Phra Singh with Nan

3) chris b. chris b. is one of my advisors from hopkins who also was on the selection committee to bring me to thailand on the fogarty. he is the head of the center for public health and human rights at hopkins and totally supportive of students. i had an hr long chat with him about my frustrations with the year so far (i dont have a mentor, im not on an NIH-funded-project, etc) and he didn't make me feel like a failure for not having accomplished those things. we're working on turning the rest of the year around work-wise, and i'm really hopeful for the next few months. chris also helped me out by writing a letter of recommendation for the wallenberg fellowship to support a clinical elective at dr. cynthia's mae tao clinic during my 4th year (more on this later).

4) liz. liz is one of my best friends from med school (and also a bridesmaid!) she just arrived
last night and is crashed on the couch right now. we've been really chill so far, and have watched two movies that she brought with her, including This Film is Not Yet Rated (about how films get rated by the Motion Picture Association in America - fascinating stuff!) and The Winged Migration (a documentary about migrating birds). we've also discussed residency rank lists, eaten some yummy thai food, and just been enjoying each other's company again.

Liz's midnight snack

reproductive health clinic

2007-01-10T21:22:00.000-05:00

i returned to my volunteer post at the reproductive health clinic this past monday. at first i was dreading going back to work and still had a bad taste in my mouth from an incident that happened right before i left for vietnam. that incident revolved around EVERYONE going into a meeting (and not really telling me about it) around 3 pm and leaving me to man clinic by myself for an hour. this was frustrating on many fronts, including:

1) it was my second or third week volunteering and my main role there is to do paps/pelvics/breast exams. id sat in on some counseling sessions up to that point but that's about it. leaving me to man clinic meant that i was supposed to greet patients, figure out what they wanted/needed, do paperwork, etc.

2) the day that they left me was a day that a local brothel's physician hadn't come in to do pelvic exams. at this brothel, all the women who are working there need to have pelvic exams twice weekly by a physician/nurse to be able to work. because the doc didn't come into the brothel that day, there were tons (maybe thirty-forty?) women who came in from the establishment. some of them were really rude to me because they thought i was young and didn't know what i was doing. when everyone was gone, a group of about ten came in, but half of them didn't have their patient registration cards (and i have no idea on how to make them) so i just did pelvics on the four that were available.

3) women (some of them with their significant other) were waiting for abortions. they were told to come at 3 pm but since everyone was in the meeting, no one was helping them and they started to get restless as time went by (i didn't blame them). i couldn't do anything about it and just kept apologizing and saying the doctor would be in soon. i talked to one white guy (probably early 20's) that i had seen the day before with his thai gf in a counseling session. the guy approached me, apologized for wearing an OSU sweatshirt, and basically poured out his heart to me.

he stated that he was pro-life but accepted his gf's decision; that he didn't have a good job now but was sure his parents would help out (he grew up in chiang mai and spoke perfect thai), that he was worried about his gf being able to conceive in the future, and that she was pretty much on her own and didn't think she could handle a kid right now. i asked him if he'd tried to talk to her about his feelings (since i feel that a lot of abortions are done because the woman doesn't feel like she has her partner's support) and he said a little, but she had her mind pretty much made up already. im not sure if she went through with the procedure (although im pretty sure she did), but it was somewhat heartening to see a young guy in Thailand want to accept responsibility for his part in the pregnancy. The day before (during counseling) he was really interested in the ultrasound and seeing the fetus on the fuzzy screen. I think he's the only guy that I've seen that's really been interested in that part of it, but I feel like it would probably be much harder to go through with a decision that most people have already made when they come in if you're actually confronted with a picture face-to-face.

anyway, it was a semi-traumatic experience overall and i left without really voicing my concerns to anyone because i was so angry.

when i returned this past monday, it was ok, and i did some Paps, pelvics, and STI exams (swabbing the cervix, vagina, and urethra). i learned that there was a new executive director (the guy i met to arrange my volunteering had been the interim director, but no one had told me that before) and one of the nurses encouraged me to go and introduce myself. when i approached the head admin person about it, she said just to 'wait until tomorrow', so i did and attended the meeting where he introduced himself and talked about his vision for the future. originally some people didn't want me to come to the meeting but i was determined not to be left on the floor again by myself and wanted to meet the new ED, so with the support of some nurses, i went anyway.

the meeting was very thai, meaning, you all sit in this somewhat dark room around a table. one person talks the whole time into a microphone, at the end he/she asks for feedback/suggestions/whatever but leaves like 2 minutes for them (nobody will give any, anyway) and then when no one speaks up, the meeting is over. this ran pretty much the same way, with the new ED talking about how he wanted to collaborate with all the ppl who had been working at PP for over twenty years, blah blah blah, but then really saying that he was the boss and things were going to change. i wasn't introduced (not a surprise) but i WAS surprised when one of the nursing assistants totally raised her hand and was like, you need to introduce tanya. i introduced myself a little bit and then suggested that they get into research and apply for grants outside the planned parenthood federation. the ED was like, yeah, that's nice, whatever, but the interim director approached me afterwards and said he thought it would be cool to write up something on the characteristics of women who seek abortions. i had gotten in trouble a little before because i had observed an abortion (and the doc who was providing them that day didnt know me, and got mad because he didn't know what i was doing there) so i haven't had a lot of experience since then, but that same doc talked to me about american medical education briefly when he stopped in that day. anyway, good news: i can likely do a project at planned parenthood and get access to their data.

some other clinic stories. on tuesdays, these master degree students (all nurses) from chiang mai university come as part of a practicum for one of their classes in community health. they have all been really friendly to me and im really happy when they're around because they're fun to talk to and they include me in things (like counseling). this past tuesday, i was able to be involved in two pretty involved counseling sessions:

1) Pre-conception counseling. The woman was 33 and her husband was around the same age. They had been trying to conceive since July but came into get blood tests. Most people in Thailand have heard about/know someone with thalassemia so this couple was mainly concerned about that. This nurse and I also encouraged them to get tested for HIV, VDRL, and Hep B. I convinced the woman to get an annual exam as well as she hadn't gotten one in a couple years, and she talked to me while she was waiting. Both the nurse and I had disclosed that we were recently married, so she felt comfortable talking to me about her concerns, not getting blood drawn before, and asking me if I had gone to get tested with my husband. I said that we both had been tested for STD's (and were already vaccinated against HepB). and told her regardless of the results, it would work out, and it would be better to know before starting a family. She had half-joked earlier that her husband had a lot of risk behavior, but I wasn't able to sit in on the individual HIV counseling sessions so didn't know the full extent of it. It was fun to talk about conceiving, pregnancy, and repro health issues with the other nurses there, and it was nice to see someone planning for the future rather than just dealing with the consequences after something has already happened.

2) HIV case. I was pulled into the case by one of the nurses, who stated that I should go see this girl just to see her eyes. The girl was 16 y/o and blind in one eye; she had an eye patch over the other eye and was accompanied by her sister (maybe 20 y/o). The 20 y/o told us that both her parents had passed away and her younger sister had been transferred to CMU Hospital from Chiang Rai (where they lived) because she had started to go blind. She ended up being hospitalized for almost a month, where she received some treatment for her eye problems , caused by zoster and CMV (surgery, meds, etc), discovered she had other ENT problems (abscess in her ears?), and also tested positive for HIV. The older sister (now head of the family) said this was the first they'd known about the diagnosis and wanted to be retested at the clinic just to be sure. She was frustrated at the hospital and had missed an appointment the previous day with HIV docs because she was charged for ENT care and was afraid that she would have to pay out-of-pocket again. I understood where she was coming from, but was frustrated because she *shouldn't* have had to pay for anything (she has a 'gold' insurance card). It seemed that she had just gotten lost in the health care bureaucracy and didn't have an advocate or someone to explain to her what was going on. The CMU nurse and I tried to talk to her about what she should do next, how to transfer care back to Chiang Rai, and I attempted to stress that her sister really needed to take her ARV on time and that they couldn't run out. After they left, the CMU nurse said she would call and follow-up with the older sister and also try to find out exactly what happened at the hospital. I felt better, but it was still a difficult situation to see, especially because ARV is made available (free) by the Thai government to those with CD4<200.

there's still so much work left to do.

bombs in bangkok

2007-01-03T22:58:00.000-05:00

after getting back to Bangkok for Vietnam, we decided to hang out for a few days before heading back to Chiang Mai. my uncle (that we always stay with) tore his gastrocnemius dancing, so he was immobile and home a lot. chris and i spent a lot of time talking to him and trying to keep him company in between eating a lion's share of farang (foreigner) food, shopping (yay year end-sales!) watching movies (we saw Deja Vu and The Holiday), and hanging out with our Thai friends - Nan, Mon, and Krit (fried chicken, papaya salad, and karaoke). i also had a chance to read both Haruki Murakami's 'new' collection of short stories, Blind Willow, Sleeping Woman, and Gabriel Garcia Marquez's Memories of My Melancholy Whores. Chris and I also got a chance to meet up with James (Fogarty fellow, S. Africa) and enjoy some quality time together.

For New Year's Eve, we didn't have any big plans and thought it would be nice to spend it with my uncle. before heading home from siam, we did some small good deeds (donated money to homeless and disabled people on the street, helped an elderly man buy a Skytrain card). We ate dinner at UFM Noodle House (totally empty, except for us) and bought some dumplings and noodles for my uncle even though he was like, "i don't need anything, i already ate." when we got home, he scarfed it down, saying "i'm not really hungry, but i'll eat it anyway" so that was good. it was then that we also heard about the bombings throughout Bangkok that had happened about half an hour earlier. about seven bombs went off within a 15-minute period at major destinations in Bangkok (including Victory Monument Bus Station, Seacon Square Shopping Mall parking lot, and Big C (like a Meijer or Target) Saphan Kwai, etc.) Everyone injured/killed in these blasts were Thai. After the news of the bombs came out, major countdown celebrations (think of the Bangkok equivalent of Times Square) were cancelled/moved up three hours. Some people ended up going out anyway, but a lot of people cancelled their plans and stayed home. We ended up calling Derrick and his gf and telling them to come home immediately; they did and stated that cops were swarming Siam and shutting down all the dept stores early.

i ended up going to bed at 10 pm and then chris woke me up a few minutes before midnight to watch the fireworks display from the roof of my uncle's condo. shortly after midnight, we saw a bunch of police cars and heard sirens heading towards downtown. i was like, 'i wonder what's going on?' i also thought i heard something that sounded like a bomb, but it was difficult to distinguish between all the fireworks. we didn't find out until the next day that there were more bombs at gaysorn plaza (another mall, and one of the corners of central world countdown) and at a seafood restaurant close by. this is about two-three blocks from my uncle's place, and down the street from where i used to live when i was on my fulbright. more thais and some british citizens were injured. after that, it's been peaceful. we heard that there had been some bombings in Chiang Mai but our neighbor (we came home yesterday) said she hadn't heard anything; im not sure what the real news is.

the press states that it's unlikely that the bombs are related to the 'Southern insurgency' . Word on the street is it's most likely due to some unhappy people in the ousted government, but who knows? it's a difficult situation now, and unfortunate for Bangkok, where I'm sure there will be less tourists for the New Year.

viet nam

2006-12-30T22:12:00.000-05:00

for the holidays, chris and i decided that it would be a cool idea to visit a southeast asian country that we hadn't been to before so we planned a weeklong trip to Viet Nam. my little brother derrick flew over from the states and met up with his gf who was studying abroad in Beijing last semester in Hong Kong. they met up with us in Bangkok and we all flew over to Hanoi together.

usually, i do all the trip planning once we get to a certain location. this time, however, i was busy with work and couldn't be bothered so chris made a lot of the arrangements. our wedding photographer, zim, was a real lifesaver and gave us a lot of great travel advice. even better, she booked hotel rooms and a driver for us in hanoi since she had just been traveling through a few weeks earlier. in any case, we arrived in viet nam with me not having researched much, a 2000 copy of Lonely Planet Vietnam, and some emails from Zim. it all worked out though.

our main plan was to spend 2 days in three different locales - Hanoi, the capitol, Sapa, a mountainous town on the border of Vietnam and China, and Ha Long Bay, a bay filled with thousands of rock formations (similar to the South of Thailand, but on a larger scale). Here are the highlights of each city we visited:

Hanoi. Hanoi is a very colorful city with no traffic lights and no traffic rules. There aren't too many tall buildings but a lot of them are very long (you used to have pay taxes based on the size of your store/house front, so people just built really long houses instead of wide ones). Although there are sidewalks, Hanoi takes 'street life' to a whole new level. It is basically impossible to walk on the sidewalks because they're filled with parked motorcycles, tea/coffee/noodle/snack shops (basically stools and small folding tables where you can watch the traffic go by), fruit/vegetable sellers, and the overflow of shop goods onto the street. This means you have to walk in the actual street, which is also overflowing with motorcycles, bicycles, cars, tour vans, more vendors, and people. There are hardly any traffic lights (and people dont always obey the ones that do exist) so it's mostly chaos, with people making their way through the traffic by using their horns. Hanoi is the first place where we noticed 'pimped-out' horns - echoing horns, horns with different tones, melodic horns. My understanding of the horn is that it indicates that you better get out of the way/go faster or you're going to get run over. Craziness.

Highlights of Hanoi included:

The Temple of Literature (first university in Vietnam, with 'doctor steles' - basically, if you get a doctorate, your name gets engraved on this plaque on a stone tortoise, which is one of the four holy animals of Vietnam).

the 'Hanoi Hilton', where Vietnamese (and also American) prisoners were held (and/or executed) during different wars.

a water puppet show (where the stage is a waist-high pool of water and puppeteers stand behind a grass curtain and control the puppets on these bamboo poles - crazy!) Other highlights included the Vietnamese Women's Museum, Ho Chi Minh's Mausoleum, and various pagodas around the city. Many of the pagodas and ancient artwork in Vietnam are very similar to Chinese art and architecture (Vietnam won its independence to China in the 1400's). We also had yummy dinners at Wild Rice (where we met up with Karyn from TTAG) and Bobby Chinn's.

Over the weekend, we took an overnight train to Sapa. The train was really dirty (they didn't change the sheets at all, and there ) even though we took soft sleeper seats. Sapa is known as a trekking destination because of its mountainous location, but we came during the weekend to also see the weekend market, where ethnic minorities from the surrounding area flood the city to buy and sell local goods. They all dress in their traditional clothing, and it's really amazing to see the different colors of cloth, headscarves, etc. all at once. Chris and I picked up a few indigo-dyed pieces of clothing at the weekend market and took a walk to Cat Cat Village, a local Black Hmong village that's been flooded with tourists and unfortunately litter (everywhere!). The second day, we booked a 16 km 'easy' trek through the mountains with a local guide and visited three villages, Y Ninh Ho, Lao Chai (both Black H'mong villages), and Ta Van (Giay village). We only ran into a few other people on our trek and it was really nice and peaceful. Most of the scenery consisted of water buffalo, chickens, rice paddies, and mountains. We also saw some cool irrigation systems built out of bamboo cut in half and a wooden pestle to ground grain driven by the flow of a small waterfall. All the children in the different villages said 'hello' and 'bye-bye' to us and some tried to peddle bracelets and other things but often got bored and just ended up tagging along for awhile. Eating highlights included: 'Sapa' style beef/pork/fish (much like Chinese sizzling plate, or tie ban, dishes), pho, stir-fried noodles, an omelette at a special restaurant run by an NGO that teaches disadvantaged young people how to cook/run a restaurant, and the ever classic traveler's food, banana pancakes.

Ha Long Bay - this part of the trip was the worst part as we booked a tour through our hotel in Hanoi and they ended up cramming us into a van and a boat. it was foggy so we couldnt appreciate the whole seascape with all the different rock formations, the food wasn't good, and we didnt get to go kayaking (as promised) through different caves. we spent christmas dinner in a 'three-star' hotel (maybe a one star hotel in the US?) and that was ok, but i flooded the bathroom since the tub and the wall had nothing in between them. thank god for satellite tv though - i watched lots of it when i couldn't sleep. overall, disappointing, so if you're headed out there, book your own private car and boat so you don't suffer the same fate as us.

Best part of the trip by far (conversation between Tanya and Chris):
Tanya: What's been the favorite part of your trip so far?
Chris: The plane ride over here.
Tanya: Seriously?
Chris: Yes. I want to go home.
Tanya: The plane ride doesn't count as part of the trip.
Chris: OK, the water puppet show.

This was like three days into it. In retrospect, we did enjoy our time in Vietnam (esp Sapa and Hanoi) but were just exhausted from doing all the planning and frustrated at a lot of the dirtiness (can we have a shower curtain without blood stains on it?). Chris said that maybe we've become snobs. I dunno, but I feel like we are getting old. Traveling with Derrick and his gf (age 20) also put this into perspective for us. In any case, I like being married. And there is a sense of comfort in getting older as well.

clinic-o-rama

2006-12-15T02:37:00.000-05:00

this past week ive been to clinic everyday (besides monday, which was constitution day and a national holiday....kinda ironic considering there is no constitution right now). i forgot how tiring it was but it's good to be around patients all the time again. snapshot into clinic life:

tuesday was my first day volunteering at the reproductive health clinic. i walked in, got a short tour, and then immediately started seeing patients. the clinic is staffed almost entirely by nurses; the doc is consulted only if there's a problem. as a family planning clinic, most people come in either to get birth control (advice on choosing a method or to buy since it's cheaper than other places), get STD testing, or to get an annual exam (pap smear, pelvic, and breast). abortions are illegal in thailand but abortion counseling is available at the clinic; there are also abortions done but it's not advertised and im not yet sure about the circumstances surrounding that yet. i was able to assist on abortion counseling for a foreign couple that came in with an unplanned pregnancy; they were backpacking around asia and didnt want to go back to europe because (as the husband stated), they 'weren't done traveling yet.' they weren't using any form of contraception and wanted to have a kid in two or three years (they were mid-30's) and as i was talking to them, i felt like they needed to think about it more. the guy seemed to be putting pressure on his wife and i felt like he wasnt really thinking about the physical/emotional consequences of what was going on....in thailand, you can get affordable, high-quality health care but i cant imagine if they were backpacking in cambodia or something somewhere and just decided to get an abortion at a random clinic. i mean, really, it's like putting your life on the line. sometimes it's hard for me to understand what people's priorities are, but i tried to be as helpful and impartial as possible (of course). im not sure what the outcome of the situation was because they were going to bangkok the next day and likely went to a clinic there.

besides sitting in on some counseling sessions, i also got to do a few pap smears/pelvic exams. at first i was nervous about doing it since i hadnt done one since ob/gyn in march, but all the cervices (i have no idea if that's the correct plural form - cervixes?) were easy to find. it's also a little different here because they just use slides and a wooden spatula to collect the cells (vs thin prep, which i think i used at beaumont). also, the women stay dressed here and just change into a sarong (or paa tong in thai) i also saw some std's, including chancroid, assisted in a condom demonstration, and watched some nurses do birth control counseling. when it slowed down near the end of the day, i also got into an interesting conversation about women's rights, contraception, and condom use with some of the nurses there.

im actually kinda surprised at how low condom use is among the patients i encounter here (usually due to male resistance. most often heard comment: "it's not fun"). i feel like thais are really focused on the present (instant gratification) vs thinking about future consequences (is having an unplanned pregnancy 'fun'? what about getting an std?) what really upsets me is hearing about people who are definitely educated about these issues (ie nurses) continuing to have unprotected sex with their partners even when they know their partners have sex with other people or even after they themselves are diagnosed (and occasionally treated) for STD's (obviously from their partner). im not sure what else can motivate behavior change if you dont care about changing after youve already had an abortion or gotten an std like hepatitis or hiv or whatever. i mean, maybe it doesnt matter after that point, but i still think it should.

wednesday: i guess i gave a good impression in clinic on tuesday because i was invited to tag along to vieng pa pao where a nurse set up a pap smear/pelvic clinic at the local public health station. we got a little lost on the way there and when we arrived there was already a line of about forty women. lots of them were also already in sarongs and i was impressed at how many people faithfully got pap smears every year to check for cervical cancer. in three hours, we saw about 75 patients. i did sixty breast exams and then did pap smears for the last hour. i also saw some std's, including a woman who likely has hiv - she had the worst case of shingles (zoster) ive ever seen and i talked to her for awhile about it. for non-medical ppl, zoster is basically a reactivation of the virus that causes chicken pox - it causes a really painful skin rash with blisters that erupt in a dermatomal distribution. she was really frustrated because she had been to the local hospital and the doc there told her they didnt have any medicine (?!) for it. afterwards, she visited a Thai traditional medicine doctor who blew some herbs on her skin lesions with a pipe, but it didnt help. she's had the lesions (one covering over a quarter of her back and the other over her breast) for about three weeks now and she's upset because (1) it's painful, (2) it smells terrible and no one wants to be near her, including her kids, and (3) she just wants it to go away. i told her there was medicine available and she should try to go to chiang mai to go to another hospital. i also recommended that she be tested for hiv, but i dont think she's going to. it was nice to be able to sit with her for awhile though - i hope it helps.

thursday (my 26th bday!): i tried to go to hiv clinic but got tired of waiting for the id doc i usually sit with (he came a few minutes after i decided to leave but ended up writing me a note apologizing, which was really nice). instead, i had a relaxing day with chris and got a nice package at the spa and went out for sukiyaki with some thai friends.

friday: copd/asthma clinic day. the doc was late as usual so i got to chat with the respiratory therapist who does pft's for awhile and observe some elderly people do spirometry. i decided that i like elderly patients, especially thai elderly people from the countryside. they all still wear traditional clothes and they're really nice and funny, except when they cant answer questions or are confused about their medication (still nice, but not so funny). i saw an interesting case of a young woman with hiv and an unknown lung disease in her left lower lobe. She was previously hospitalized for 4 weeks because she was coughing so much and couldnt swallow anything - later they found out that she had ulcers in her esophagus and some vocal cord problem as well. despite biopsy and cultures, no bug has been found, so they're presumptively treating for tb. she's gotten a bit better but is still having trouble eating and is losing weight. interesting, but also sad.

that was this week in a nutshell. chris and i have been having good times in thailand, and went bamboo rafting down a local river with a bunch of friends for Father's Day (also the King's 79th birthday) last tuesday. at night, we attended the Royal Flower Show in Chiang Mai and lit candles for the King. it was really patriotic and fun, and made me happy to be a Thai person. The King is a really amazing individual and recently won awards from the UN Food Program and Time Magazine in Asia for his commitment to sustainable agricultural development for the poor in Thailand. :) Yay leaders for social justice!

weekend warriors

2006-12-08T20:25:00.000-05:00

i know, ive been really crappy about updating again, but i have a semi-good excuse! chris and i have spent the last four weekends out of chiang mai (i posted on two of them)...and then i got sick. i still have a sore throat now but it's not too bad if i don't talk and don't try to swallow anything. anyway, a short synopsis of what's been going on:

last weekend: mae salong. mae salong is known for tea, akha villages, and chinese-thais.

we just tagged along with gig and aum, who went to visit their good friend goh. goh's family just renovated their wooden house into a guesthouse on this mountain (mae salong). his uncle also just opened 'mae salong farmstay,' where you get your own private bungalow and bathroom overlooking these tea plantations. highlights of this weekend included getting to eat lots of yummy yunnanese food, seeing a tea plantation and an orange plantation, and visiting some akha villages to ask them if they still planted cotton or did traditional weaving. we saw old akha women turn freshly picked cotton into thread using this wooden spool-like device, but noted that no one really did traditional weaving anymore (they just buy everything with wages from family sent to work in the city). gig might set up some projects like he did in lampang out here in the future.

two weekends ago: bangkok.

chris and i hung out with a lot of old friends, including amalee (from fulbright times) and her bf dave, nan and krit , and karyn (executive director of Thai AIDS Treatment Action Group). as usual, our two days in bangkok centered around food and shopping. highlights included dessert at the oriental hotel shop at central chit lom with karyn, katak (fried chicken, papaya salad, etc) in siam with krit and nan, oishi all-you-can-eat japanese/thai buffet with my uncle likhit, and tha chang (thai/western fusion) with amalee and dave. we miss bangkok a ton (esp public transportation!) in the two days we were there, we took taxis, boats, and the skytrain. it is nice to have a motorcycle in chiang mai though.

work update:

leprosy hospital visit:
last thursday i went to visit mckean institute/hospital, which used to be one of the largest leprosy centers in the world. it's now focused on rehabilitation for people with physical disabilities and it was pretty amazing. we got to go on ward rounds with a trauma-surgeon-turned-family-physician, take a tour of the facilities, and talk to one of the missionaries whose worked on disability for over thirty years in thailand and se asia. she told us a lot of interesting stories and talked about how holistic their program was - they tried to not only address medical issues for people with disabilities, but also encouraged independence and tried to help the disabled generate a sustainable income and be accepted in their communities. they had disabled people working in the workshop making prosthetic limbs, special shoes, etc, and also a large store where people were trained to do handicrafts (cards, jewelry, lacquerware, woodcarving, etc, most with a christian theme) - many of them did them at home and then came to deliver their work about once a month to the shop. also on the grounds was a large village for elderly disabled/old leprosy patients, organic farms, chickens/pigs, and more. everyone seemed really excited to be given a second chance there and it was very :) ....i found myself wondering if they all had to convert though, and then felt unhappy that i was thinking about religion especially because it was clear that they were doing such amazing work and having a great impact on these people's lives, who were often abandoned by their families after they were disabled. i wonder if it's from being american and the climate about religion there and the (often) christian right doing things that don't seem very christian to me. anyway, it was also interesting to see how most of the hilltribes had been converted to christianity, although we saw one kid on a motorbike with a bumper sticker that said 'missionaries suck'. i wonder if he knew what the sticker said, but he sped off before we could ask him.

reproductive health clinic:
i made a connection a reproductive health clinic and went to talk to the director there. he had obviously not read any of my email with my cv and was just interested in whether i could see patients (i said i couldnt without supervision) and when i wanted to volunteer. it was difficult for me to get any information about programs they had there. i think what ended up happening at the end was that i agreed to come in on mondays and tuesdays and shadow in clinic (and likely do some pap smears and pelvic exams) and then they would take it from there. they have some interesting projects, like a group with elderly people to talk about sexuality, and some focus on hill tribe issues, so i'll see. the head doc was also supportive in the fact that he said i could likely do a small project if i saw something i was interested in and could have access to their medical records. i start volunteering there on tuesday.

im interested in doing a small project in hiv clinic where i interview HIV+ women about reproductive health/contraception/family planning. ive noted that a lot of women are in serodiscordant relationships (meaning their partners are HIV-, as their previous partners have likely died) and some are interested in bearing children, even though it's generally discouraged by the docs in clinic regardless of their health status. im not sure if the nurses have a role in discussing contraception but i'd be interested to hear patients thoughts about it, so im putting together a proposal right now and maybe will be able to start interviews in jan/feb.

sustainable development

2006-11-13T02:13:00.000-05:00

This past weekend, Chris and I joined three friends (Aum, her boyfriend Gig, and Pae) on a trip to a rural village, Nadau, outside of Lampang. Although we went primarily for relaxation and to get out of the city, we got to learn a lot about local issues through Gig’s work in rural Thailand as well.

Gig used to work for the government in grassroots community development but left to work as a ‘free agent’ after he began to disagree with some of the former government’s politics and stances on issues. One of the projects he’s been involved in is the one we visited, where a group of about thirty people are part of a co-op that produces cotton clothing and housewares (blankets, towels, tablecloths, etc) from start to finish. There are people responsible for planting and harvesting organic cotton, spinning the cotton into thread, weaving the cotton, dyeing the cotton (using natural dyes from local plants and trees), and selling the finished products. We stayed at the co-op leaders’ house, which is a complex of small open buildings in this really beautiful natural garden setting that’s designed by one of the couple’s sons. The different buildings at the complex included a meeting room (also doubling as a dining room/living room), a small shop, a ‘library’/breakfast room, a kitchen, a bedroom for the couple in charge, a weaving room (where all the looms are kept), a garage (where machines that separate seeds from freshly picked cotton), bathrooms, and an adobe house that was also primarily built by one of the couple’s son. All five of us stayed in the adobe one-room house as it was built as a guest house for people who were visiting the co-op.

Gig showed us around the place and during the mornings, I was able to have some conversations with him about social justice. He stated that he was committed to preserving traditional knowledge and was unhappy that much of this knowledge was being lost because many youth were uninterested in learning about this way of life and also because locals thought it was a better use of time to purchase cheaper goods (usually from China) rather than making them themselves. Because of this, many of the fields were left empty because there were not enough people to do the work that was required to maintain them. Also, less and less people were engaging in traditional work (bamboo weaving, weaving cloth, growing cotton, woodwork, etc.). During our visit there, we visited a few elderly couples who were employed by the co-op or others to make traditional objects (like bamboo woven containers). However, prices for these objects had fallen in recent years and I was saddened to hear that this elderly couple only received 2.5 baht per bamboo container that they wove by hand.

Continuing our conversation about the loss of traditional knowledge in rural communities, I asked Gig if youth had opportunities to obtain an education. He stated that it was dependent on the family, and that many youth did have opportunities to attend Rajabhat (basically the equivalent of a community college in the US, but more vocational/technical focused). Although he agreed that it was important and useful for youth to get an education and experience life in a city, he wished that more youth would come back after receiving an education and contribute to local development rather than seeking out desk jobs or other employment in the city. However, it was rare to have anyone come back once they left. It was interesting to note that through all our travels in the village, we rarely saw anyone our age at all (it was essentially all elderly people and young children).

Re: education, I noted that it was important to have ideas of community development and/or social justice present during the college years. Gig agreed but stated that few majors talked about such ideas and that most people went to college to make money. He majored in sociology and had a few profs talk to him about community development but he stated that his friends in the more popular majors of business, accounting, management, finance, etc. never had any discussions about rural or community development. I found this sad, especially in Thailand, where there are still large amounts of rural poor. Even more interesting, I thought it was interesting that Thailand has a pretty robust civil society (look at anti-Thaksin demonstrations, or demonstrations against the Thai-US FTA, anti-smoking legislation, etc.), but wonder where the youth are? Where is the training ground for progressive-minded people? What activities are college kids involved in? (There are few extracurricular activities from my limited experience talking to friends both here and in Bangkok).

Back to the village though. During our stay, we were able to pick cotton, see elderly people making traditional crafts, look at traditional looms, and see villagers harvesting rice. We also had a chance to visit with some local families. Everyone was super nice and welcoming to me after Gig introduced me as ‘the American doctor’ (kinda uncomfortable, actually, but I did get to look at some medical records – written in English, of course, so few Thai people can understand them, and offer some advice). Some of the elderly people tried to chat with me but I don’t really understand Northern Thai so it was mostly smiling and nodding. It was also super hot and I feel like I’m turning into my mom (getting migraine headaches in the heat). Chris was a little grumpy but tried to grin and bear it. After we got home, he noted that he kept thinking that he was really lucky when we visited some of the rural elderly people in their homes (mostly wooden houses on stilts with bamboo mats on the floor). This reminded me of the times I used to argue with Chris about how he grew up rich and privileged and he would get upset and say he wasn’t rich at all (compared to lots of other USC kids he went to school with). It amazed me how difficult it was to convince someone that they were privileged but thought it was easier for me to accept my own privilege because of my parents’ background. Although I have no recollection of difficult times (my parents were still struggling when I was born), my mother would often talk about her experiences as an orphan and I remember visiting her older brother in a Bangkok slum the first time we came back to Thailand. At that time, I was fourteen and thought, we are really lucky to have been born (to my parents) in the US.

During this trip, I was reminded about how little people really needed to survive – not just how little people needed to just survive, but also to survive and be happy.

slacker

2006-11-09T23:32:00.000-05:00

ok, i have to admit that ive been a huge slacker ever since chris got here and have basically disappeared off the face of my work-related activities. i've tried to get back into the swing of things today though, and am proud at myself for editing a pretty poorly written paper, writing three work-related emails, and taking out charts i'm supposed to review (even if i haven't started really looking at them yet).

it was a huge relief to be back together with chris and it took almost no time at all to adjust from living alone in my roomy studio apt to living with chris again. he brought our wedding album and all our pics (so ive looked many many times at them and shared them with a bunch of people), nutter butters, and a foam topper for the mattress and new sheets :). he's also more attuned to cleanliness than i am, so the apt has been kept relatively clean between the maid visiting and me cleaning up to make the room presentable for my teacher when she comes to teach me thai. big news in the past few weeks includes:

1) motorcycle purchase. aum ( a nurse from the MA project) and gig (her bf) took us to buy a used motorcycle last weekend. we paid about $500 for a used automatic bike (yamaha nuovo) and it's in super good condition. i just got an oil change and tune-up at the yamaha garage for $7. craziness.

chris almost made me fall off the bike the first day we got it while we were practicing riding around, but i saved myself. he's getting better everyday and is the main driver as i'm scared of traffic and can't really balance him on the back of a bike.

it is REALLY nice to have an independent mode of transportation rather than take songtaews (or red trucks) everywhere. gas isnt that expensive for bikes either (we spend maybe 100 baht a week, or less than $3) on gas a week, vs a little less than a dollar for both of us to go on one ride anywhere in the city.

dont worry, we always wear helmets :).

2) loy krathong

loy krathong (festival of light) was also celebrated last weekend during the full moon. in the north it's also called yee peng and it's a BIG deal. you can read more about the history and significance of loy krathong in this article here. basically, the festival is to pay respect to water and its centrality in people's lives (main theme in lots of Thai traditions, including the New Year Festival, Songkran).

chris and i attended two parades with intricate floats and also made our very own krathong (float) in a lanna village (did you ever have colonial days in your elementary school? this was exactly like that, but nicer - basically, they set up a platform with people playing traditional lanna music, weaving traditional cotton clothes, making traditional desserts, etc. there was also a station where you could make your own krathong). lanna is how northern Thai people refer to themselves and their culture. lan in thai means one million, and na means fields (ie rice paddies)...so one million rice fields (guess what people used to do here for a living). anyway, krathong are really cool and are made from environmentally friendly materials, mostly from the banana tree. the base of our float was made from a banana stalk and then it was covered with banana leaves. i am bad at folding, so chris took cues from aum as to how to fold strips of banana leaves into triangles that are supposed to resemble lotus petals. i assembled the banana leaves onto the base and added some flowers they had there. finally, we topped off our float with a homemade candle and three incense sticks (for the Buddha, the Dharma (the Buddha's teachings, and the Sangha (the monastic order and those who follow the Buddha's teachings). although real thai people probably thought our krathong was really crappy looking, we were proud of it just the same. :)

after making the krathong, we bought a khom loei (or floating paper lantern...you basically light a candle under these things and wait for it to produce enough hot air until it rises into the night air like a hot air balloon...see pics in the slideshow for more) and then drove to the Ping River to float our krathong and light the khom loei. Floating a krathong with your partner is supposedly good luck and will ensure happiness and good fortune together. Before letting our krathong float down the river, we each put a strand of our own hair in it and a coin. Putting your hair in your float supposedly helps to wash away the bad things in your current life and helps you start afresh. You can also pray and/or make wishes before letting your float go in the water. Chris and I decided to wish for a happy future together and good health for both of our families. Luckily, our krathong floated without any problems and the candle did not burn out (it is bad luck to have your candle burn out before it leaves your sight). Hopefully our wish will come true :).

After floating our krathong, we lighted the khom loei and let it go with Aum and Gig. You also get to make wishes and hope that 'badness' floats away with the khom loei. the night sky during loy krathong is amazing because of all the khom loei in the night sky (like lanterns everywhere).

enjoy one of our loy krathong slideshows here :)

Get Your Own! | View Slideshow

3) new work-related project. vit and i went to check out m-plus, a drop-in center and clinic offering free std and hiv testing for male commercial sex workers. the director wasn't there and they weren't really expecting us, so we didnt stay long, but i was able to join a meeting the m-plus coordinators had with rihes (the research institute where i work) this past week. im going to check out more opportunities there next week and maybe will volunteer to teach english (much like i did at empower during my last yearlong stay in thailand).

4) celebrating accountability. chris and i watched election day coverage on cnn all day in Thailand and celebrated the democratic takeover of both the senate and the house. unfortunately, proposition 2 (banning affirmative action in Michigan) passed despite our absentee ballots.

ok, those are the main things for now. ill update more after our weekend trip to lampang with aum and gig :).

slide show!

2006-10-25T07:25:00.002-04:00

Get Your Own!