coup d'etat

As many of you already know, there was a coup d'etat in Thailand on Tuesday night. Basically, General Sonthi Boonyaratkalin, the army chief (who was sacked by the PM Thaksin Shinawatra) took over (with the support of other armed forces and the national police). The Thai PM was in NY at the UN General Assembly and so wasn't around to stop the army surrounding the Government House, his residence, and other key points in Bangkok. Thai TV channels were also taken over and regular programming replaced with videos of the King and Queen and songs about them that people note were associated with coups in the past. In the beginning, no one really knew what was going on (whose side where the soldiers on?) but a series of announcements were made on behalf of the coup leaders, who are calling themselves the Democratic Reform Council. The first announcement gave the reason for the coup ('The current government administration has caused conflicts and undermined the harmony of hte people as never before in history...The nation has been governed in a corrupt manner...The council is steadfast in its objective, which is not to take over the government permanently and it will return power to the people as soon as possible.") The second declared nationwide martial law. The third coup announcement noted that the current constitution (written in 1997) has been abrogated and the House of Representatives, Senate, Cabinet, and Constitution Court were dissolved; however, other courts retained their authority. Gen Sonthi has stated that he will be the acting PM for the next two weeks until the Democratic Reform Council can get things in order. They expect to have elections within the year (the previously scheduled election was to be held next month), and people are looking to see whether or not they keep the ir promise.

Many Thais were not surprised that the coup occurred as there have been mass protests calling for the PM to step down (resulting in snap elections held earlier this year). These elections were later voided due to possible election fraud and the refusal of opposition parties to participate. While many do not support Thaksin because of his actions, people I have talked to generally say that they wished that an alternate path was taken to bring him down from power. However, most talk is behind closed doors now because the political future of Thailand is uncertain, although many express hope for a better future.

So far, daily life hasn't been affected by the coup (although Wednesday was declared a national holiday). However, there is a rule against assembly now (more than 5 people should not be assembled together) to promote peace. In Chiang Mai, I saw a police officer and army officer together at the mall the day after the coup. A patient who works with the Air Force also noted that his leader has thrown his support behind Gen Sonthi and is now accepting orders from him, which most military units appear to be doing. The military has announced that it has the King's support and many are wearing yellow armbands as yellow is the color of the King. Yellow shirts are traditionally worn on Mondays this year to celebrate the 60th anniversary of the King's ascension to the throne and show love for the King (I'll post a pic of this on Monday, as I just picked up a yellow shirt last week). Thai people love and respect the King as one who loves his country and uses his power to work for social justice, especially poor people. The King has opposed Thaksin's rule and has made thinly veiled remarks against him during his Kingly speeches, including advice that Thaksin should listen to others and hear opposing views ( It seemed that Thaksin was trying to sue everyone who spoke against him for libel at one point). So far, the King hasn't made a public speech, and some people I've talked to suggest that he will not. Gen Sonthi has stated that the King was not part of the coup plans, however.

That's it for now. Obviously, I didn't present a very detailed analysis of anything but you can all read more about it on the Internet if you'd like as I'm not sure who is (and is not) reading this blog. An interesting article that was forwarded to me today in the Asia Times titled "Thailand: All the King's Men" can be found here.

Thanks to all of you who sent emails or IM'd me to make sure I was okay; it's nice to feel loved in my home away from home.

workin' and groovin'

At a food market with Poo (bags of curry go for 15-20 baht, or around 50 cents each)

With the exception of the day-after-the-coup, these past few days have been the most productive days of my fellowship, both personally and professionally. However, I’ve also developed a little homesickness (which I didn’t really expect a month into my time here) that has led to insomnia. I think a lot of the homesickness has to do with missing Chris and the feeling like we’re always somehow in transit re: our schedules and don’t get to talk as much as we would like to.

On the personal front, I’ve made some new friends at the MA drop-in center (Baan Ruk Puen, the House of Loving Friends in literal translation, but more like ‘Where Friends Care for Friends’) and hang out there often in the afternoons even though it’s looking more like I won’t actually be doing any data analysis with the MA study as all the data is essentially taken already. Ying, one of the more outgoing interviewers/youth outreach workers there, invited me to go to the ‘Walking Street’ with her Sunday night. There are two walking streets in Chiang Mai (Sat and Sun nights) and basically they shut off a portion of downtown to cars and people just come and set up stands (or put a sheet down on the pavement and their wares on top of it) and sell all sorts of things, including clothes, gifts, art, food, etc. There are also some street performers. I hadn’t been in a few years and this one has gotten a lot bigger; Ying and I spent about three hours walking around and didn’t see the whole market. I picked up a pink ‘I love Chiang Mai’ shirt and a present for Chris. Good times.

On Monday, I received my first motorcycle lesson from a nurse at the MA center. She was giving me a ride home from Baan Ruk Puen and was like, let’s go and ride now! I was a little shaky with balance at first but eventually felt comfortable riding around in this empty parking lot after about an hour. It was fun and I’m getting a hang of switching gears and whatnot. However, I’m still a little terrified when it comes to riding in Chiang Mai traffic, which has increased significantly over the past few years. I’m going to have a few more lessons and hopefully will buy a secondhand bike sometime this week or next. :)

Food update:

I finally tried the Taiwanese hole-in-the-wall restaurant that’s right next to my apartment building, and it kicked ass! I had some jaozi (pork dumplings!) for 40 baht ($1) and fried rice with Chinese sausage (lap chang) and it reminded me of living in Beijing again.

Over the weekend, I also had some pasta at this local restaurant (catering to farangs) and got to chat with one of the head waiters there, who asked me why I could speak both English and Thai really well. I told him a little about my background and he told me his sister died of HIV/AIDS a few years ago. He didn’t really know much about HIV but I told him that treatment was now available through the universal health care program in Thailand using generic drugs produced by the Government Pharmaceutical Organization (GPO-vir, which is a combo of d4T, 3TC, and NVP). I’m not sure if he believed me, but I think it’s good to try and educate where you can.

Last night I ate dinner with Poo and Nui at CMU’s undergrad campus. Every night they set up food stalls and the food is yummy and cheap. I had some fuktong (Nui says it’s a kind of pumpkin) that was super yummy, tofu with pork, and lab (special northern thai dish) with pork. Pork is really common in Thailand, much like beef is in the US. My favorite part of the meal was the pineapple smoothie though (fruit smoothies are sold all over here and made with fresh local fruit) – it was 5 baht (about 12 cents). My quality of life (foodwise) is seriously better here than it is in the states.

Work life update:

All my meetings have been really productive and exciting over the past few days and I now have a better idea o of what I’m actually going to do here, which includes both community work and also clinical work. Some projects I’m going to work on include:

• Access to care for HIV+ IV drug users. This was supposed to be a substudy under a larger multinational trial comparing oral suboxone vs. methadone as opioid replacement therapy for heroin users, but was not funded because it looks at treatment (rather than prevention) and also because US funders didn't think that it would 'add anything new' to what is already known (drug users have problems accessing care). Totally helpful, I know, especially when 30% of Thailand's IDU's are HIV+ and that rate hasn't changed in over ten years. Anyway, I'm going to look into applying for some grants and will probably be the person-in-charge for this project, so that's really exciting! I'll get to go on home visits, interview drug users, and analyze the data. There's been a preliminary proposal written so far but I think we'll have to scale back due to the lack of funding. The head PI here for the project is really chill and a family doc (also with a PhD in public health and really into harm reduction and drug use). I met him two years ago when a JHU prof sent me up here to check out the site and he commented that he didn't recognize me because at that time I seemed very "young, energetic, and outgoing." I wonder what that says about my past two years in medical school ;)

I think I've changed a bunch since college though in terms of becoming more grounded in my work, what I expect from myself, and what I expect from others. I also have different kinds of relationships now, both professionally and personally. Personally, I think my family dynamics changed after my mom was sick and I helped take care of her (weird to switch roles - I'm happy she's better now so I can go back to being a kid in a way). Also, I'm married now and look forward to having a family of my own (!) :)

Sometimes I still find it hard to believe that I'm both a mentor and a leader to others but I think it's really important to be supportive of others and try to meet people where they're at. I like listening to other people's stories (good to be in medicine cuz you get to hear lots of them...even ones you sometimes don't want to hear, like this one patient who would not stop talking about his rash for 30 mins today) and giving advice...more often than not though I like helping people think about what they actually want to do because I think that's more important...and way more useful to the person in the long run.

• Back to the work theme. Other things I'm going to be working on include some different writing projects - a possible review of penicilliosis in immunocompetent patients, writing up the data from a quality of life pilot study done a few years ago among HIV+ patients, and maybe designing my own little project on quality of life among the patients in HIV clinic. I'm giving a journal club this upcoming week on cryptococcosis in immuncompetent patients as well.

Clinically, I sit in with Poo every week at HIV clinic (we see between 10-15 patients during a ~3 hr morning clinic on Thursdays and Fridays) and join on ID inpatient rounds if I'm around during the afternoons. I also attend weekly journal club, where Dr. Kuanchai always notes that I'm 'clinically inclined' to Dr. Thira. :) Actually, I'm interested in everything, but I think people don't quite grasp that. It's okay though because I get to split my time both at the hospital and in the community. I'm looking to volunteer at some local NGO's (like Thai Drug Users Network) as well, so that should be cool as well. :)

Next post: life post-coup (generally the same as life pre-coup), but a little quieter...

getting my ass into gear

so the last two days have been (surprisingly) productive since ive decided that i want to definitely be started on a few projects by the beginning of october.

thursday:

i should've gone to ID outpatient clinic in the morning but thought it was wednesday for some reason. instead, i walked down to smoothie blues, a family-owned place catering to primarily farang, and had a yummy breakfast consisting of pancakes, eggs, bacon, and fresh orange juice. i also read part of the bangkok post and the august 2006 uk version of marie claire (which has way more articles in it, btw) before meeting up with ben for lunch at a local street food stall.

in the afternoon, i went to meet with some people from the methamphatemine (MA) study. The head person had originally suggested i look at some of the questionnaire data on tattoing, so i met with the behavioral data person, A, to look at the questionnaire and get some of the data. i helped translate the questionnaire into english and A said she would help me if i figured out what i wanted to look at. i have no statistical background whatsoever, but she uses SPSS (ive been told by multiple friends now that it's worthless, but that's what she has), and checked out some books for me from the library on how to use it (i'm picking these up on monday). later, i bonded with some of the MA head people by showing them wedding pics from the US. they noted that most of them were single (A has a boyfriend but he's getting his PhD in Tasmania now) and that it was hard to find men who would date highly educated women. also, it appears that many of the older women chose between having a career/education and having a family. kinda sucks.

anyway, after i met with a, she suggested i go over to the drop-in center (Baan Ruk Puen, or the House of (loving) Friends - sounds dumb in translation, but it's fine in Thai). i did, and hung out with a bunch of the interviewers/youth outreach workers there; most of them are women (i think there are 2-3 guys out of maybe 12 people). it was fun; i told the story of how i met chris and answered questions about being thai-american and just got to know everyone better. all the single girls were like, "Where's the other fellow? the head person (Orn) said she would bring him over today so we all got dressed up." it was kinda funny though because the head person also told them that he was 21 or 22, but he's really 28. random.

when they were getting off work, they invited me to go eat at this all-you-can-eat steak buffet held at a hotel. i tagged along and ate mostly thai food (the steak wasnt great), including tons of fishballs, for about 70 baht. lots of hotels in thailand also have these karaoke singers that sing during your dinner. there were two at this place who sang separately (a woman who sang thai songs and a gay guy who sang english songs). it was kinda hilarious because the gay guy just made up some words that weren't really in the songs, but nobody caught on since everyone was thai there. i think it's interesting that many singers here likely sing phonically (is that a word?) rather than knowing the actual meaning of the words they're singing...or that's what it sounds like, anyway.

after dinner, i ended up staying up pretty late (for me, that's like 1 am here) and emailing up a storm. i set up a meeting with this family doc who does a ton of drug research here (i want to investigate other areas for being involved while waiting for the suboxone vs methadone trial to start - ill probably do interviews for the access-to-care subproject in that trial, which looks at barriers to care for hiv+ iv drug users). i also emailed some local NGO's to see if i can get involved in some way, and wrote to the head of this Advanced Study of Thai program at UW to see if he could give me any leads for an advanced Thai teacher in Chiang Mai. sometimes i wonder if all those years studying mandarin were a waste (i remember so little now, but still understand it). oh well, we'll see what happens - i haven't ruled out returning to china in the future. :)

friday:

woke up early (around 6) and then went back to sleep until 8. got up, and got ready for ID OPD clinic. poo was post-call so she got to clinic a little later than usual and i had time to pick up iced coffee and sweet rolls for breakfast. this is the first time ive been to clinic before it's actually started so i got to hear the head nurse give a PSA-style speech about wearing condoms as an HIV+ person to avoid spreading the disease (and also to avoid being superinfected, or receiving more virus), the importance of taking meds daily and at the correct times, etc. She also gave some basic information about clinical trials that were currently enrolling and encouraged people to ask questions about meds if they had any when she met with them personally (all patients meet a nurse briefly to pick up meds and make their next appt after seeing the doctor).

there weren't as many patients in clinic in the morning (we saw 10 in less than 3 hrs). i took notes while we saw patients though and observed that of the 10 patients we saw, 6 were women. five of these women found out they were hiv+ because their husbands/partners had died, prompting them to get tested. the first patient was 22 and said her boyfriend died last month. she was obviously anxious and had no clue about hiv, what CD4 count meant, what she should do, etc. poo was kind to her and tried to lecture her about basic hiv stuff like no meds until CD4<200,

I'm interested in gender differences between quality of life among men and women and also on women's perspectives...I feel like I would be so angry if Chris was like, 'By the way, I have AIDS', or just died on me and then I found out I was infected from him...not that you can do anything about it at that point, but it's frustrating - and probably really depressing, especially if you're widowed. Today (this is a week later now, because this post was half deleted) we saw a 52 year old woman who was clearly depressed, recently widowed, and was now living with her youngest child. She said the older child didn't know her status and she was embarassed to tell him. She just started taking ARV and looks pretty cachexic. Sad.

Back to last Friday - in the afternoon, I hung out at the MA drop-in center and asked to observe a 3-month follow-up questionnaire with a 20 year old in the MA study. it was really interesting to see the effect of MA use on this kid (who seems like a really nice guy, student at a local technical institute) - he clearly had no concentration and had to ask to have a lot of statements/questions repeated, including the one asking if he had any problems concentrating in the past week. He seemed really out of it in terms of dates too and had to repeatedly look at a calendar to see what days comprised 'last week' or 'last month'. However, he impressed me by being able to answer all the 'tell me whether you think this statement is a myth or a reality' questions (some of them were really tricky; they had to do with drug use and/or sex) and being really adamant about condom use. Right now he states he has about 5 regular sexual partners but uses condoms with all of them...good thing, yeah?

Friday night I had a yummilicious burger at Mike's Burgers and Wawee coffee with Ben. Ever since then, I've had a burger craving, but am in general liking the fact that I've cut way down on red meat, eating pork and chicken instead. Poo apparently thinks I've lost weight as well (Thai people are obsessed about weight and will likely comment on whether they think you've gained or lost weight almost everyday).

A funny story (in retrospect) having to do with weight:

On Wednesday and Saturday nights, there's a market set up outside of the mall across the street with local food vendors and others selling clothes and knicknacks of different sorts (cell phone holders, umbrellas, hello kitty pencil cases, etc). There's also foot massage chairs set up and I thought I'd get an hr massage for 3 USD. Unfortunately, the woman who was assigned to give me a massage was convinced I was pregnant. She was an older (maybe 50-60ish) and meant well, but as soon as I sat down, she was like, "Oh, are you pregnant?" And even after I replied in the negative and told her I was actually just 'fat' , she kept harping on it and making comments like, "But your legs are really swollen and it's like when Thai people are pregnant and are going to give birth!", "You should go see the doctor and get a pregnancy test," and "Oh, are you still single (implying virginity)?" I think we spent half an hour on this topic and the massage was actually pretty painful in multiple ways. Oh well, though. Thai people I told the story to thought it was funny and that the masseuse was a little out of line, but that's life. At least I know that it wasn't just me being offended after awhile.

rant

this is a rant.

as many of you know, i speak thai and im thai american (both parents are thai, born and raised in the us). you may think this is an asset considering im in thailand. however, in matters of being introduced to people i work with, it totally is not.

case in point: today i was excited to go on my first field visit with PA-Thai (Project Accept Thailand), a trial that's complicated to explain, but the jist of it is that there are seven different sites (communities) in Northern Thailand and three teams: Community Mobilization, Voluntary Counseling and Testing, and Post-Test Support . The three teams go to each of the communities separately eight times (in 'rounds') over a period of two years. The point of the trial is to take community-based voluntary counseling and testing for HIV to rural communities. By doing this, the study group will obtain epidemiological data on HIV infection rates in (more) isolated communities/different ethnic groups, give HIV education to communities, and provide support for those who test positive. It's actually pretty cool, and a lot more in-depth, but I think that's enough info for now.


Today I was assigned to go to Mae Tang (a 1.5 hr drive from Chiang Mai in a 4-wheel drive vehicle) with a VCT group which consisted of a team leader, two nurses (one counselor and one lab person to do the HIV rapid tests), and the driver. The head of the whole VCT group also rode in our van. She also has 'porn' in her name and her nickname is Bee. Anyway, she was super nice to me and spent a long time explaining the VCT component to the trial to me including the different ethnic communities they were working in, what the data had shown so far, and how they were trying to make modifications in their work based on the previous two 'rounds' (they're on their third round, or third time through the communities right now). After this intro, she had to go do QC at the other site (where the other Fogarty fellow was) but I tagged along to see it since it was in a Lahu (ethnic minority) community.

I was there briefly but got sent back to the original site in the event that there were cases I could sit in on. The original site has 50% Thai speakers, so Bee thought that there was a good chance that I could understand if someone came to get tested. Alas, there were zero cases. However, that is not my rant.

A nurse and our driver talking at the rapid test table

The community center where the VCT was set up in Mae Tang

My rant is that in the 6 hrs I spent at the site (consisting of an open air room with aluminum ceiling and mats to sit on on the floor), hardly anyone talked to me. I tried initiating conversation multiple times but no one was interested even though they were clearly bored out of their minds. I eventually ended up taking a long nap instead and reading 'Jonathan Strange and Mr Norrell', which I left in the car on the way back home (Grrr). I was told that some people on the team were disappointed that I was chosen to be with the team because they originally had thought I was Thai and they wanted to speak English. I told them multiple times to speak English to me but they refused. They also asked me if my English was any good when I first met them (I was like, yeah, I'm American). Finally, they all got up to go buy snacks at a local store but didn't invite me. When they were halfway down the road, I was like, "Where are they going?" The person they left in charge of the VCT booth was like, "Oh, to buy snacks. Do you want anything?" I was like, whatever.

Meanwhile, people talk to the other fellow all the time. I know because I was at the other site (although the two ethnic minority ppl talked to me there) and also from conversations with him. I am not mad at the other fellow or jealous, I'm just frustrated with the situation. The situation being that I am not viewed as being 'cool' or 'interesting' or 'worthy of really talking to' because I can actually speak Thai and my parents are Thai. This happened to me when I was working in Bangkok and two Dutch students came for the summer to do a study on HIV+ children. They spoke no Thai but everyone wanted to be seen with them and/or hang out with them/help them in every way they could. I only ever went out with the non-white staff there once, and that was with the Dutch girls, even though I had been working there for a year. I tried to explain this to Poo, the ID fellow, but she didn't really get it. She likes me, anyway, but it's sad sometimes to only have one friend.

She's a good friend though. She invited me to ID Journal Club yesterday. It was pretty informal - just me, her, the resident who gave the presentation, and the attending doc who also happens to be the head of the Research Institute for Health Sciences (where I'm based) and the ID Dept. I had scanned the paper quickly before the presentation and was able to make some semi-intelligent comments. Poo noted that the attending thought I was diligent (score!). I was also introduced to this Chinese resident, Helen, who was born and raised in the UK. She married a Thai dude (his family owns this huge mall here and is mega-loaded) and then moved to Chiang Mai, where she's doing a neuro residency. Craziness. I am trying to figure out who her Thai teacher was (she can read and write and is totally fluent) and maybe will look into some of the data the neuro dept collects on intracranial mass lesions in HIV+ patients (med ppl: mostly toxo, crypto, some TB). I really like ID. I am going to do it (this is probably not a surprise to any of you). :)

eek! i havent updated for a week!

im not sure what happened, but it appears i havent updated in a week. instead of boring you all with minute details of the last seven days of my life, i'll attempt to provide a quick synopsis.

i spent the past three days (i took a long weekend - sat, sun, mon) in bangkok. about 90% of the time was spent at bangkok hospital, where my uncle is recovering from a 3vCABG (translation for non-medical peeps: triple bypass). the hospital is a private one and crazy nice...on the ground floor there's an S&P (bakery/cafe), Au Bon Pain, 7 Eleven, and more. my uncle called it a 'hospitel' (combining hotel and hospital)...i found it to be like a spa. Anyway, if you're in a private room, you need to have someone stay with you overnight, and so this weekend that person was me. Most of the time there were other people around, and i got to hang out with four cousins i didn't really know well before since most of them had only recently moved up to bangkok for work. their nicknames are cha'ay (peekaboo), nit noi (a little bit), nong (younger one), and oam (i dont think there's a translation for this). they're all around my age, which is cool. maybe i'll get to see them more when i go down to bangkok, but i think it was awkward for them to interact with me because they assumed i couldnt really speak thai (even though i can, grrr). oh well.

other highlights of the weekend included catching up with old bkk (bangkok) friends, including nan (a bridesmaid in my wedding and a cardiovascular icu nurse at the largest public hospital in thailand), krit (gay dude who is a super great friend and took me to the airport yesterday), noi (red earth makeup artist at siam square - she did my makeup and hooked me up with free makeup applications in chiang mai) and amalee (fellow fulbrighter who has lived in bkk for the past five years and works on development/child trafficking issues). i miss bangkok!

pre-weekend highlights.

friday: my neighbor and landlady chi (chinese-american mom) invited me to hang out with her on friday morning, so we went to run errands while she showed me around town. we got our nails done at this local place, and i got a nice french manicure and pedicure done for 350 baht (almost $9). she also took me out to lunch at this local vegetarian restaurant (all you can eat for 65 baht - $1.50) and introduced me to this homemade ice cream place (yay custard apple ice cream). we talked about asian american stuff, living abroad, and other interesting things. good times, fun stuff!!

friday night: dinner with ben and some admin ppl at the research institute where i 'work'. this one girl would not stop talking about going out with her friends and getting drunk. needless to say, i lost interest after awhile. her friends were even like...'smile and nod'. at least she gave me a ride home though.

thursday: i went to opd (outpatient) clinic with poo from 9 AM-1 PM. there were about 110 patients for 2-3 docs to see in the morning. saw lots of hiv cases, some sad cases of patients who decided to change their own meds and ended up developing resistance, one of a cachexic hill tribe woman who didnt understand any thai and didnt have an interpreter, a guy who looked fine but had a CD4 count of 4. got a new phone from the research institute and am just figuring out how to use it (still) but it's loads better than my old piece of crap. thursday night, i got this massive headache and felt sick, so could not really enjoy eating at this restaurant next to a waterfall that poo and nui took ben and i to. after taking some ibuprofen i got better though, and poo, nui, and i went to the night market (really small scale jj, open stalls, cheap clothes that i cant fit into because im too big).


wednesday: kickass 2 hr thai massage, 240 baht ($6). other stuff as well, but not as exciting.

today:
i have grand plans to get a bunch of stuff accomplished - going to journal club in the afternoon and will try to read more papers and get a proposal together to look at quality of life among the HIV+ cohort here. also plan to check out the gym across the street - im getting tired of being sedentary and also im really sick of people telling me im really fat (thai people are super bad about this. two examples from the weekend: one woman, who's my aunt's friend, was like, 'you're tanya? i thought you looked familiar; i met you a few years ago, but you've gained so much weight now. wow, you're really fat! how many kilos have you gained?" Example number 2: my uncle (who i went to hang out with at the hospital) saying, 'hey, if you gained a few more pounds, you could enter the miss chang (elephant) contest (for super huge women in thailand).' uh..thanks.

more updates to come :)

luck be a lady tonight

a short post on last night happenings...overall, i had a totally unproductive day but got picked up to go eat 'jim joom' at this thai buffet after poo got off work. jim joom is northern thai suki where you basically pick whatever you want to eat and throw it in this ceramic/clay pot filled with soup on a burner. this thai buffet was ginormous and in addition to all the fixings that come with jim joom (seafood, meats, veggies, etc) there were snacks (like steamed buns, shu mai, cold salads, etc), a large grill where you could grill your own meats and whatnot, and this dessert bar with ice cream, thai dessert (including shaved ice with additions like beans, corn, tup tim krob, etc), and a toast bar. toast is really big in thailand with some little cafes specializing only in milk (all flavors) and toast. there are yummy spreads to put on your toast here, lots of them of thai fruit and also other things that im not sure how to explain in english.

anyway, jim joom was fun because there was live music and it was in an outdoor setting with an aluminum roof top. even funner (yah, i know, funner isnt a real word, but i like it just the same) was that a mahout came with his elephant and stood outside. the elephant was really happy and kept dancing, and kids would go out and buy sugar cane or bananas to feed it. poo fed the elephant and then told me that the elephant was 4 months pregnant and it's good luck if you walk under a pregnant elephant's belly three times. i thought to myself, 'self, you can always use some good luck', so went to the elephant, wai'd to it (traditional thai greeting of respect), and walked under her belly and around her in a circle three times while the mahout (elephant caretaker) recited a blessing. afterwards, i paid the donation of 59 baht with 60 baht and got a lucky baht coin (like a penny) in return which im supposed to keep with me and not spend. pretty kickass, if you ask me. not everyday you get to walk under a pregnant elephant.

right now im at the hospital in the id staff room and am thinking about going on afternoon rounds with poo and her resident tong (poo later told me not to come with her, so im just hanging out in the id room). this morning i had a short discussion with dr. kuanchai about maybe doing something with the adult hiv+ cohort they are following at the university hospital here (about 1000 patients) - dr. kuanchai says no one has done anything about adherence or quality of life, so that would be something to look into (i could also use my thai skills and administer the questionnaire myself while pts were waiting in opd (outpatient) clinic). anyway, i need to think about it more and look up some past literature and stuff, which i will do immediately after i finish this entry...which may be now. :)

weekend

overall, my weekend was nice and relaxing.

saturday was a solitary day, but it was good for me to remind myself that it's ok to be alone and i can actually amuse myself without other people around. i started the day off doing some laundry (yay hand washing) - you pay by the number of pieces you wash here so i just do my own underwear (sorry if this is TMI for some of you :) ). after that, i went to a local spa for a body scrub, massage, and facial. very nice (anyone thinking about coming to visit...definite thailand perk!!)

after the spa, i headed over to this local cafe (wawee coffee) that serves really yummy coffee and has these huge branches with both indoor/outdoor seating and fountains and gardens. i usually get iced coffee there and read the daily english-language newspaper here (the bangkok post)...it's kinda ironic that im often more up-to-date on news here and what's going on in the world than when im back in the states. btw, judy and i found the most kickass article on nyc's oldest bartender, hoy wong, while we were also engaging in similar newspaper-reading activity at said wawee coffee. if you are interested in reading the article, click here: http://www.msnbc.msn.com/id/14462796/

after i was all caffeinated and ready for more adventures, i attempted to locate the art gallery where my co-worker's husband was having an opening for an exhibit on abstract seascapes. i thought it might be down this one soi (sois are side roads/alleys off of main roads) that is known for boutiques, antiques, and other fun stuff so i wandered down there and went into a bunch of stores. the whole soi was mostly empty since it was late afternoon on a saturday so i had fun browsing but didn't buy anything. later, i got a text msg telling me that the art gallery was actually 2 sois over from where i was, so headed over there and found it to be packed. the art was really awesome (and also affordable) and there was a good mix of people (all ages and both thai and farang. fyi, farang means foreigner (generally white) ). my colleague introduced me to a cool farang couple that does advocacy work in chiang mai (they're older, but still young - probably early 30's) and i spent a long time chatting with them. we were later joined by vit, who was sporting a green shirt that had a lime with fangs on it. on further questioning, the lime with fangs represented a familiar on this online rpg, kingdom of loathing. we made fun of it for awhile, but vit convinced me to check it out when i got home. i now admit that i am mildly addicted to this game, but you should all check it out too (you can wikipedia it if you want) - it's a pretty kickass rpg that just makes fun of rpg's and pop culture in general . plus, everyone is a stick figure. what's not to love?

i also had some kickass noodle soup at this noodle stand that vit recommended (thai-ish noodles, but all the workers there are shan) on my way home from the art gallery. it was 20 baht (or about 50 cents). if i just ate on the street or in small shops all the time here, i would spend less than $2 a day on food.

sunday:

poo and nui picked me up around 11:30 for a day of chiang mai adventures. first, we grabbed lunch at this thai place a little outside the main city (menu for lunch included cha boran (like thai iced tea), sukhothai tom yum noodle soup, satay (chicken sewers with peanut sauce and cucumber/vinegar sauce), and som tum moo yoh (pork sausage with papaya salad - moo yoh is awesome and eaten a lot in the north)). poo was impressed by my spicy-eating abilities. i was amused because my family is from Southern Thailand (known for the spiciest food EVER) and they always think im a huge wuss. anyway, poo gave me props for being able to eat spicy when compared to non-Southern peoples.

after lunch, we stopped by an ancient monastery, wat umong, to feed fish (they were full though and nothing ate our fish food, but i saw a snapper turtle!) and visit Buddha images, kept in ancient caves. the temple also had wooden signs tacked up to the trees with Buddhist proverbs in both english and thai. one that i remember stated, 'all honest work is honourable work,' which reminded me to humble in my daily life (i feel like docs often get a big head about themselves and why their work is more important than others). the temple setting was really beautiful (ill upload some pics soon) and we were visited by a monk, who gave us a short dhamma talk on how it was less important for us to visit the temple regularly than to try and observe the five precepts everyday in our daily lives (take home message: do good in your daily life to reap the benefits of karma). he also asked us which of the five precepts we found it hard to keep, and nui answered that he still drank beer. (i first thought that the monk asked us what the five precepts were, and i said, 'to not kill people'. then nui was like, no, what ones are we still deficient in? lol). the monk talked about why drinking was no good (losing money, causing health problems, other stuff) and poo later made fun of nui after we left the temple. anyway, im not capturing the essence of it, but it was nice to have a chat with a monk, who urged us to try and make a commitment to keep the five precepts for one day. btw, the five precepts are:

1) Do not kill (or intentionally harm other living beings)
2) Do not steal (or take what is not given to you)
3) Do not commit sexual misconduct (also be respectful in relationships)
4) Do not lie (or speak harmful thoughts)
5) Do not do drugs (other than for medicinal purposes)

poo and i had a short discussion about the 4th precept because she noted that she sometimes had to lie to patients re: their diagnosis when their families didn't want the truth to be told. this is common in asian cultures where younger ppl make decisions for elderly ppl and it might be bad luck/bad form to tell an elderly person they have cancer or some other diagnosis. i dunno how i totally feel about this (growing up in the western culture of autonomy), but i've read a lot about it in the past during my medical anthro/bioethics courses and think it's interesting.

oh, the temple visit also reminded me of a discussion ben and i had with a monk at wat suandok about how buddhism is a way of living and people don't need to be 'converted' to Buddhism. More on that later, perhaps.

After the temple visit, we drove up to this reservoir and got some fruit and drinks at this cafe overlooking Chiang Mai. we also saw a couple in western wedding wear taking professional pictures outdoors, which got us talking about poo and nui's upcoming wedding (next year) and me and chris's love with taking pictures in thailand. lol.

Later in the afternoon, we went into full shopping mode, with stops at Tesco Lotus and Central Airport Plaza. Poo paid some of her telephone bills and signed up for ASDL and UBC to be connected in her room at the hospital, and I picked up a big fan (good to save money on electricity and also :)'er for the environment vs. A/C) and some towels. Exhausted from walking around the mall, we ended the day at this large covered outdoor market (talat in thai) that's actually not too far from my condo. the talat sells everything, but we only went to the food stall part. food stalls here are awesome, and basically sell a bunch of premade food (curries, stir fry, etc) on these huge platters. you pick what you want and they put a serving into a small plastic bag for you and tie with a rubberband (ill also upload a pic of this later). at this talat, a single serving of food is 20 baht (or ~50 cents). i picked up a small roasted catfish (25 baht), stir fried vegetable (kinda like a cucumber, but not) with egg (20 baht) and a single serving of steamed rice (5 baht) for dinner. i ate the leftovers for breakfast this morning, so that was definitely a worthwhile meal :)

yay for chiang mai adventures! i think i will pick up a motorbike soon. :)

mo'c mo'l

this week has seemed crazy long so i (and poo) were way happy when it was friday. btw, poo is a machine. she works the entire day post-call (call=staying overnight at the hospital and answering calls on id patients and sleeping little, if at all) and then still goes out partying at night. it is really ridiculous. anyway, yesterday was one of those crazy days for her.

in the morning, i joined her in ID clinic (mostly HIV+ patients). one dude had a CD4 of less than 10 and we examined his chest films (patients carry around their medical records with them here). it was pretty cool (but sad); we saw textbook PCP, then a CXR after treatment with the PCP resolved but another new nodule forming (the pt had complained of chest pain in the area as well), and now they're thinking he could have Nocardia or something; they need to bronch him to try and get sputum to stain and culture. He can't start ARV treatment yet and he is sad. I hope he doesn't die before he can start. Also, I saw this pt that was being transferred from another hospital with cryptococcal meningitis. he was stiff as a board and unconscious. i was surprised more people weren't freaking out (his family kinda was) but most of the staff around were like um...let's see if we can find an open bed on our ward. he really looked like badness (fun term that medical ppl use to connotate exactly that..badness). ill check on him next week after he starts his amphotericin B.

after ID clinic, we had khao soi (yummy noodles with this spicy soup - kinda like curry, but a northern thai specialty) to celebrate the end of the short course and the Japanese docs' stay. I got relegated to the 'adult' table (go figure, even though im the youngest kid) and ended up talking to this japanese doc who came to supervise the other docs (he's an md/phd and has a really funny body habitus - basically, he has a huge paunch but small arms and big legs and a kinda smallish head and he is balding). he is nice and tries to make jokes but it's funny because sometimes they don't make sense and then the thai doctors are like what? and then laugh awkwardly. im actually really surprised at how bad the japanese docs english was. anyway, we had an interesting conversation about female physicians (he said that Japanese female physicians were discouraged to continue working as a physician after marriage and asked about the situation in the US), University of Michigan Med (I forgot that there was a Japanese health clinic run by the family doc Michael Watters (i don't remember his name) at UMMS), the medical education system in US, and American college life. the cool head ICU doc was also there and said he was nervous about this presentation he was scheduled to do in the US in the fall. apparently his presentation was one of fifteen picked to compete for this international research award and he's nervous about his english (although it's really pretty good), so i offered to help him go over his slides and listen to his talk. I'll also investigate potential projects with him. :) Poo says he has much power in the hospital, and he's really cool.

At the lunch, I ate crazy amounts of food, including yummy thai fruit (longan!) and this ridiculously yummy ice cream sandwich. Ice cream sandwiches here are actually like real sandwiches - sweet bread with ice cream in the middle. It's actually really good, and there are people who make homemade ice cream and sell it on the street in hot dog buns (seriously) or hamburger buns. You can also add toppings to it, but the toppings are things like corn and beans. It's actually pretty yummy (I know it sounds gross, like bananas and cheese...but that's actually yummy too! Chris and I ate it unknowingly in Brazil).

in the afternoon, i went to a peds id lecture with ben (sadly for ben, the slides were all in english but they all talked in thai). a bunch of peds fellows/attendings gave short presentations on their research re: the immune response to HIV+ children who receive different types of vaccines (Hepatitis, Japanese Encephalitis, MMR, etc). There was also a review of immunology, and i forgot how much i enjoyed that sequence. perhaps i should investigate peds projects as well.

i am totally impressed by how much literature people read here (including residents). it's also all in english, which is their second language, but there's tons of journal clubs and just informal reading all around. i need to start reading more, as usual.

in the evening, we went out with this japanese docs again to this really awesome indoor/outdoor cafe/bar/restaurant named mo'c mo'l (short for monkey club and moon lover). it's open but covered (so you dont get rained on), there's raft-walkways between the cafe and the restaurant/bar part, live music, and fish and frogs in the pond they've constructed...think tropical garden). there was tons of food, as usual, and rotating thai bands that sang both english classics and thai songs. dr kuanchai (young id doc, poo's boss, and totally awesome dude all around) was rocking out to some of the music. the japanese docs all got drunk on beer and bacardi blueberry/vanilla liquer. kinda hilarious, but also kinda fun. after mo'c mo'l, poo, nui, ben, and i went to the original monkey club near where ben lives for more food and a fleeting moment of clubbing (mostly it was us going in to the club area to try and find poo's friends) most clubs here are packed, there's a thai band playing covers of current hit thai music, and people stand around their tables (or carts) and kinda dance and sing along. ben was dragged into the melee and said he was afraid. it was good times, anyway, but i turned in right when i got home.

on the agenda for the rest of the day: 2.5 hr spa treatment (body wrap, massage, and facial) at chiang mai oasis spa and maybe lara's husband's art opening at a local thai gallery in the evening. i havent been that productive since waking up, but did hand-wash all of my underwear (cost for laundry is per piece, so i think it's a waste to throw in underwear) and caught up on email.

hey, people, if you're reading, comment so i know this isn't all going into a black void!!

nerdy post (skip the first part if youre not into medicine)

so the last few days have been an interesting mix of learning more about the different research projects that are going on at RIHES and tagging along with this group of visiting Japanese docs that are here for an intensive short course on infectious disease. Some highlights included:

One day of lectures (this is like going back to med school, but it's stuff I'm actually interested in, so I liked it. Also, it was the Japanese docs being pimped, not me J ) Topics covered included anthrax, ARV (antiretrovirals for HIV) in Thailand, TB, and dengue.

I also went to another lecture on infection control in the hospital and on antibiotic resistance in the ICU – it's totally crazy; the head ICU doc here is really super dedicated and does his own monitoring of all the pts admitted and their bugs and resistance profiles. Based on the drug sensitivities, he creates protocols every few months that he tries to get the other docs to use and when the sensitivity profiles change, he changes his protocols. He also went on this massive hand-washing campaign to try and get nurses, physicians, and other auxiliary staff to wash their hands before and after contact with patients (by hiring random people in the hospital to observe pre-and-post patient handwashing, he found that in a step-down icu there was only a 2% handwashing rate before pt contact – craziness!)
Anyway, I think the stuff he’s doing is really interesting and might meet with him to see if I can contribute in some way since his sample sizes are pretty small and are focused on the university hospital. Btw, the university hospital officially has ~1200 beds but unofficially they just put extra beds in and most ppl think there’s at least double that amount – it’s crazy).

Rounds in the ICU (for you medicine ppl out there, one of the main bugs here in ppl with acute exacerbations of COPD and/or hospital-acquired pneumonia is Acetinobacter baumanni. How weird is that? Pseudomonas is in second place, and MRSA is really not common).

Adult ID Rounds. We saw the craziest case of this 21 y/o woman who originally was admitted with spontaneous pneumothorax. Her lung didn’t expand after they put in a chest tube, and then they saw all these loculated cysts on CXR that ended up being ECHINOCOCCUS. How crazy is that? Even CRAZIER though is that she kept having a fever and was found to have empyemas throughout her pleura on Chest CT. When they went in to take out the pleura, they cultured the abscess fluid and found ASPERGILLUS. So now she’s getting antifungal meds (amphotericin B here) and is s/p a 3 wk course of albendazole for the echinococcus. Totally wild, even for Thailand. Other cases I saw included probable Strep suis (from pigs) infection causing a brain abscess and right-sided visual loss and hemiparesis and these weird skin lesions, cryptococcal meningitis in an immunosuppressed diabetic with rheumatoid arthritis, and miliary TB/tuberculous meningitis in this super old dude who was disoriented and had fever (he also was previously treated for a UTI but his neuro status hadn’t improved). I really like ID and am almost 100% sure I will do a fellowship in it or maybe just fast-track into it out of medicine residency.

Meeting with the coordinators of the MA (methamphetamine) study and the PA(Project Accept)-Thai Study. The MA Study is a kickass study that has over 2000 subjects that are between 18-25 year olds and either use MA themselves or are the sex partner of someone who uses MA. There’s a really extensive baseline questionnaire and then follow-up questionnaires every 3 months for one year. There’s also an intervention (but it’s over already) that runs for a couple of hours per week for eight weeks vs. a control group (also lectures for 2 hrs for 8 wks, but there’s not much interaction and uses a government-sponsored ‘life skills’ curriculum). Anyway, there’s some preliminary data on MA use and tattooing (which is really common here) and I might do some work with that until the suboxone trial with IV drug users gets off the ground, so that’s exciting. I visited the MA drop in center they have set up near the University today and met the team that works there and had lunch with them. Thai ppl are often pretty shy when you first meet them (esp if you can speak Thai and are from somewhere else) and only a few people talked to me, but it seems like a fun place to work. I’ll probably set up a meeting next week with the data coordinator to look at some of the surveys. The head people for the study are also super cool and I totally get along with them.

The PA-Thai study is huge and entails bringing voluntary counseling and testing into different communities surrounding Chiang Mai, including hill tribe and rural, isolated communities. They go to communities every weekend to do community mobilization and run the clinics and I’ll probably join them next weekend (Ben is going this weekend, but I had originally planned to go to Vientiane, Laos to visit Judy…I dunno now because tix are expensive and hard to find, but I might go and check at Lao Airlines (randomly on the first floor of my building tomorrow). There’s more to the study, but I won’t go into it now.

Outside of work, I’ve been hanging out with my fellow Thai Fogarty fellow named Poo (it means crab in Thai, and isn’t pronounced like the word youre thinking of). She’s a first year ID fellow and we get along really well; she reminds me of my other Thai friends in Bangkok. We often go out to eat and I’ve been hanging around the ID office whenever I’m free. She also took me to Tesco Lotus with her boyfriend Nui and Ben and I got a bunch of stuff for our rooms. Yay people with cars!

Ben and I also went to Monk Chat yesterday at Wat Suandok, a temple which is part of a monastic Buddhist university. Monk Chat is basically held for monks to practice their English and for Westerners to learn more about Buddhism. We talked to some monks from Laos that were studying in Thailand and it was pretty cool (aside from getting eaten alive from mosquitos). I would like to go to the temple more and get back into chanting/meditation/listening to Dharma talks while I’m here.

On my to-do list: check out yoga places, find a new Thai teacher (I think the one I went to for two hours ran out of stuff to give me), learn how to ride a motorcycle.

feeling somewhat productive

so today was a good day...there are no more formal meetings scheduled for ben and i, so we're pretty much left to our own devices to figure out what we want to do. fortunately, this morning there was a CAB (community advisory board) meeting so ben and i sat in and i translated some of what was going on for him. it was pretty interesting, actually, and a variety of topics were covered (recap of the International AIDS Conference and the Global Village held there, a presentation on a study of the different places people can buy and drink alcohol around Chiang Mai, review of the current data from a study that's going on regarding voluntary counseling and testing in communities surrounding Chiang Mai, introduction of a study that Merck is planning to do re: the new HPV vaccine in HIV+ women, and more...) it was actually really informative and interesting to hear from non-medicine types (PLWHA, or people living with HIV/AIDS and community members) although i don't really understand Northern Thai dialect. after the CAB meeting, there was a yummy served lunch.

in the afternoon, ben and i hung out with our site mentor, dr. vit (also a thai american who's been working in thailand for the past few years) and chatted about the different studies that were going on, politics (both in thailand and abroad), the shan, and other fun things. before i knew it, it was 4 pm and i had to book it in the rain to my first thai lesson, where i ended up reading tons of proverbs /allegories and then answering reading comprehension questions about them...the reading comprehension questions reminded me of 2nd or 3rd grade, but it was a good time). My Thai teacher attempted to convince me to try and do some dictation but I refused. I might do some tomorrow, but I really don't remember how to write Thai at all.

Anyway, I'm going to try and go everyday for this first month since it's going to be slow at work until I figure out what I want to do. I'm really interested in this trial that works with injecting drug users but there's some administrative holdups right now and we're not sure when the trial will actually get off the ground (hopefully by the end of this year). In any case, I'll probably check out some other studies in the meantime, including one that just ended testing a six-week intervention for youth (focusing on sexual health, decision making skills, etc.) who are both sexually active and active methamphetamine users. the interventions just ended :( so i won't get to see any of them but i think there could be interesting data to look at and im also interested in analysis and writing, so we'll see.

Tonight was also Ben's bday so me, him, and Vit went to eat Korean food. Entertainment for the night included random drunk Korean dude in the back taking off his pants and then the girls with him giggling. It was a little too much excitement for us and we headed back home. So, that was my day. Not the most exciting, I know, but I feel like I'm settling in and making progress on a few fronts (including finding someone to do my laundry - this nice American lady who relocated to Chiang Mai a year ago and lives down the hall invited me in to chat for awhile last night and told me I could have my laundry done with hers and that it would be picked up and delivered weekly for ~ $1.50. how sweet is that!!!)

back by popular demand :)

I know I haven’t updated in ages, but the last few months have been a flurry of activity (school-related and otherwise) that it’s taken me awhile to even get to the point where I can face the blank page staring at me from Microsoft Word. I figure it’s time to start writing again though, especially because I’m not scheduled to do any more extensive traveling over the next few months.

Currently, I’m settling into my new digs in Chiang Mai, Thailand. Chiang Mai is the second largest city in Thailand and is located in the North – population estimates fluctuate between 150,000 and a couple million people, mainly because it’s difficult for people to agree on what’s considered Chiang Mai due to urban sprawl. There’s also a huge expat community here and tons of tourists. Sometimes when I go into the Old City I feel like it’s a gigantic Khao San (the backpacker area of Bangkok). However, I’m excited about living here (once I make some friends) – lots of people love it because it’s filled with chill nightlife (but also clubs), coffeehouses, art galleries, temples, cafes, and more. I’m planning on buying a motorcycle or scooter (Vespa, anyone?) to get around since there is effectively no public transportation here aside from taxis (tuk-tuks) and songtaews, which are these red converted pick-up trucks with a cover in back that pick people up wherever they go and then eventually get you to your destination. They don’t follow any prescribed route, so unless you’re going somewhere close, it’s difficult to estimate how long it will take you to get to where you want to go (not the most convenient thing). Also, it’s much more expensive than what a bus would cost…too bad there are no buses in Chiang Mai.

In any case, I arrived in Chiang Mai last weekend. I’m going to be working with the Research Institute for Health Sciences (RIHES) and met with some PI’s (principal investigators, or the people in charge of research studies) last week to help give me an idea of the different studies that are going on right now and where I can fit in. I need to decide what I want to do and am really excited about this one study that looks at access to care for HIV+ IV drug users, but want to keep an open mind and also gain clinical experience both in and outside of the hospital setting. The other fellow (a friend from Case Med, Ben) arrived about 10 days before me and had the opportunity to go on ID rounds and also to clinic, so I’m looking forward to that. Although it’s slow right now, I know that it usually takes 3 months whenever one goes abroad to really start doing anything, so I’m on track of where I want to be – I found an apt (roomy, centrally located, fully furnished studio) the second day I was here, moved in, and I’ve already had a visitor (my friend Judy from Swarthmore, who is finishing up her post with Population Services Intl in Laos). It was actually really nice that she came and crashed with me for a few days because it lessened the shock of me actually being alone in a city I didn’t know. We didn’t really do anything but hung out, talked a lot about college, life, what’s going in the US now since she’s going back (I made her watch the White House Press Conference with Stephen Colbert), and ate yummy food. Exactly what I needed though. I might go visit her in Vientiane (Laos) next weekend before she packs up and heads home.

Pre-Chiang Mai was madness. After finishing up the Fogarty orientation course in Bethesda, I spent two or three days in Baltimore at Hopkins meeting with the US investigators and doing logistics stuff (payroll, health insurance, etc.) since my Fogarty fellowship is administered through the Hopkins School of Public Health. I also took the Thai Fellow to the Inner Harbor so that she could see her first aquarium, hung out, and ate seafood. Following my few days in Baltimore, I flew home for a night and then got on a plane the next morning to Los Angeles (where my now-husband is from). I think I might take a hint from him (those of you who've seen our wedding website story will get this)and just condense the rest into a timeline:

• July 5-18 – Bethesda, MD for Fogarty orientation (like a mini-course on global health) at the NIH. All US fellows and foreign fellows (we’re paired to encourage capacity-building at our foreign sites) attended and it was fun getting to know everyone from all over the globe.

• July 19-21 – Baltimore with Ben and the Thai fellows.

• July 22 – Fly to LA with Chris on the 6 am flight. Arrive in LA, pick up rental car, go to Glendale Galleria to find a dress with sleeves to wear to the Thai temple, and then run to get my hair and makeup done for the Chinese Wedding Banquet held that night at this huge Chinese restaurant in Monterey Park (Ocean Star). About 300 people attended our Chinese wedding banquet (held by Chris’s parents). I knew about 20 of them, but it was all good. We got to visit each of the 30+ tables and toast them with wine goblets filled with warm Coke in our hands (warm Coke generously provided by the Chinese banquet manager…I think I would’ve preferred wine, seriously).

• July 23- Thai Buddhist Ceremony at Wat Thai in Los Angeles. My parents got married at this temple almost thirty years ago and hadn’t been back since, so it was cool to see how much bigger it was. The ceremony consisted of nine monks chanting, us offering alms to the temple, listening to a sermon on marriage, and other rituals surrounding the wedding. It was really nice, although Chris didn’t understand what was going on a lot of the time because everyone was speaking Thai (we translated later).

• July 24 – I took USMLE Step 2 CS (the clinical skills portion). This seemed like a good idea when I scheduled it, but I seriously studied for like 2 hrs the night before. I think it turned out okay anyway, but I was really exhausted. After USMLE Step 2 CS, we went out for Chris’s mom’s birthday at this Shanghainese restaurant before taking the red-eye back to Michigan.

• July 25-August 4 – pre-wedding planning. Two of my best friends from Thailand, Nan and Mon, arrived on July 28^th to hang out (it was both of their first times in the USA) and help out. They were super invaluable and loved being bridesmaids in an ‘American’ wedding. During these two weeks, I had my bridal showerette/bachelorette party in Royal Oak (thanks Liz and Suhani!!), had a civil ceremony with Chris in Chelsea (in Buddhism, marriage is secular and not religious) and got 'officially married', bdid last minute wedding stuff (wrote the program, made the seating arrangements, etc.) and prayed I would fit in my Thai wedding dress.

• August 4 – Rehearsal and rehearsal dinner in Ann Arbor. Everywhere was relative central (family came from Chicago, Texas, California, DC, NY, Canada,Thailand)…

• Aug 5- I had to wake up before 6 am because the wedding started at 10 AM in Grosse Ile (I got married in my parents’ backyard), but had my hair and makeup done in Ann Arbor. A high school friend did my makeup (we used to play soccer together and do theater together and were reunited on myspace) and it was wonderful. My photographer actually drove me around the whole morning (and also to the wedding) and we had a really great conversation about being Asian-American (among other things) while driving to my parents’ house. The wedding was really awesome – we had both Thai and Western ceremonies (with accompanying dress changes and both kinds of food) and were surrounded by our family and friends in two large tents in my parents’ backyard. I wrote most of the Western ceremony (which was non-religious) and Chris and I told stories about each other and also wrote our own vows (some of which included Dr. Seuss J). Although we had some technical difficulties with the speakers (the music kept cutting in and out because the tent was far from the house), all the guests started singing ‘Close to You’ when the music cut out and we were dancing with our parents – it was really cute. My dad also had his first public speaking debut and gave a really amazing toast. Anyway, y’all probably don’t want to hear too much about the wedding. Take home point: it was kickass!!

• Aug 6-15 – Honeymoon in Brazil! Chris and I spent time in Salvador, Recife, and at Muro Alto Beach (Nannai, Porto de Galinhas). We watched a lot of DVD’s, ate a lot of food, and had good times together.

• Aug 17 – I flew to Thailand! Although I'm happy to be here, I'm sad that I'm alone and won't see Chris until December. It reminds me a lot of when I first started dating him four years ago and was living in Bangkok while he was living in LA. Before coming to Chiang Mai, I spent a day with my friends Nan and Krit in Bangkok, mostly at Siam Paragon, and saw some of my family.

Okay, that’s the update on my life. More humor to follow. Y’all better be ready to start commenting. :)

what i love about america

Since I’ve been back stateside, I’ve spent some limited time at home and more time in Bethesda, Maryland for Fogarty Ellison ‘orientation,’ which basically consists of me sitting in a very uncomfortable chair in this parlor/library for around seven or eight hours a day listening to various lectures covering topics such as bioethics, hiv/aids, neglected diseases, and clinical research. i don't think the curriculum was well thought out though because it's kinda a mishmash of random things that could be important without a coherent structure. I actually appreciate the time I spent in Geneva a lot more and even though it was crazy and long, the WHO/Duke/HEI weeklong class that I attended during the last weeks of my stay there.

This morning we had an interesting discussion with the foreign fellows (all of us US fellows are paired with other fellows from the countries we’re going to) about the ethics of research in low income or resource poor settings. That was somewhat cool, but a lot of it is not. I was reminded of my conversation at WHO with a Brazilian physician and pharmacist who were instrumental in Brazilian AIDS Program about the Global North/South divide, the fact that people continue to die everyday because they can't access treatment, and the need to get drugs & diagnostics out there NOW with or without 'gold standard' techniques like viral load. I'll write more on this later, because I've thought about this a lot over the past few years that I've been involved in global research/health care.

Anyway, to get back to the title of this blog entry: what I love about America. A short list follows:

1. Tastee Diner (or any diner). Sitting at the counter and talking to the short order cook. The ‘regulars’ at these places.

2. Hamburgers (Thiru, I did have a cheeseburger at Sidetrack Grill my first day back). It was yummy, and it was $5.95.

3. Most people speak English, a language I understand J

4. Being able to drive when I feel like it

5. Really big washers and dryers (compared to Europe) – I did almost all my laundry in one load. Amazing.

6. Big coffees (this is for you, Kim) – most European coffees are tiny (like half the cup, but they are yummy)

7. 24 hr stores like Meijer

8.Everything (or most things) open on Sunday, like the mall!

There might be others, but that’s what I can think of right now. Bethesda is not cool, but I’m staying with my friend Ben (who’s also going to Thailand with me). We often have dinner together and it's been good times meh'g and weh'g, among other things. I've also had a good past few days post-class catching up with friends in DC. One night, I met up with my friend Karlo who went to policy school at Michigan and is now working at the University of Maryland, his alma mater. We were in the Asian American Graduate Student Caucus together and have had lots of good times, including ice cream and/or beer study breaks. Karlo bought me a glass of wine at the Science Club, a bar/restaurant in DC. When he first told me the name of the place while I was talking to him on my cell, I definitely thought I was hearing things. Science Club? It sounds like a high school nerd club. Turned out it wasn’t, but they do have random science paraphernalia around, like microscopes, solar systems, and beakers. Anyway, we had a good time talking about the revolution, interracial dating, marriage, smoking, and the makings of a rock star. I didn’t talk too much to the other policy people who were there because I didn’t feel like I really had anything in common with them and didn’t understand this one guy’s path to becoming a politician…in any case, that isn’t really important. What is important is that I’m happy I saw Karlo and had a glass of wine.

Last night, I went to Raku (this pan-Asian restaurant) with Jay, Davekumar, and Harold (from Harold and Kumar go to Cinque Terre!). He was in town for a world tobacco control conference, and we met up to have an AMSA pow-wow, talk about organizational stuff, and just hang out. Jay and Dave are some of the people I feel closest to from my time in AMSA and when we’re together, it’s like family. We ate a ridiculous amount of tapas/appetizers, including agedashi tofu, calamari, vegetable egg rolls, ginger mussels, and more. Later on in the night, Harold joined us. Harold is an OAT (Old AMSA Type) and was able to offer sage advice on organizational issues. More importantly though, it was interesting to hear about the history of AMSA, the different struggles (and the same ones) med students faced at the time, and of course, random gossip. Interesting topics we talked about included admissions criteria (for medical school or fellowship) & humanity in medicine, mentorship, wikis, strategery, and more.

It is good to feel loved in a place that isn’t home.

good times in good ol' geneve

During my last two weeks in Geneva, I didn’t go to work that often (but I was in class, so I have a valid excuse), but I also didn’t really blog. I had a great time during the end of my stay though and actually was sad to leave, especially because I ended up meeting a lot of cool people (y’all know who you are) through the fellows program during class. Here are some scattered memories that I wanted to jot down while still jetlagged, so I can pretend I’m still somewhat in Geneva. I’ve always found it hard to blog about my experiences in another country after the fact, and since I’m now back in the US, I want to get down as much as I can before I lose the essence of what it was like for me to be in Switzerland.

In no particular order (and definitely not of importance), here are my fave memories of Geneve. (Sorry for the inside jokes, but someone will get them who reads it)

- Googlechat with kim at work, ‘WHAT is your father’s name?’ Sharing stories from our respective childhoods involving such entities as dance teams, the Thai Community, most embarrassing moments, crappy ex-‘s, and more. The implosion of the African Studies Institute at Columbia. (This was not a fave memory, but the use of the word implosion was). Kim as mystery friend to other people we know.

- Long lunch meetings at IOM with thiru

- Cocktails and dinner with Cecilia and crew. Finding out Cecilia is also Theravada Buddhist! Listening to policy wonks discuss (while drunk) issues such as access to second line treatment, a new approach to research and development, and the selection of a new Director-General for the WHO

- Late nights at Central Perk (I will enclose a picture – it’s really a café that’s scammed off of the sitcom FRIENDS)…food and drinks with my two bf’s in Geneve (you know who you are)

- Watching World Cup Matches at Scandale, this lounge/bar in Geneva. Once when I was there with Nina, watching as the place turned into a Japan/Australia reception with random white people doing taiko drumming immediately after the match ended. The place being infiltrated by tons of Japanese expats.

- Jeck’s place with Kim and Thiru. YUMMY! (can we get a bigger carafe of water possibly?)

- D-Vine (a wine bar) with Kim, clueless waitress (the wine bottles ARE labeled), and drunk dude who was excited that we had put our feet up on other chairs.

- Thiru introducing me to some cool peeps at the WIPO (World Intellectual Property Organization) Development Agenda Meeting. People from Brazil arguing about the best place to go on a honeymoon (Chris and I plan to go to Brazil!) A guy from IP-Watch remembering me from looking at my resume! 80 centime coffee!

- Sweet beer at La Terrasse, which still reminds me of a random frat party.

- Falling asleep on the little motorboat Roxanne, Amit, Aditya, Jenny, Jen, and I rented in Lausanne

- Getting giggly on the train back from Montreux

- Swapping boy stories with Roxanne

- Cheering for Portugal in a sea of British fans during the England/Portugal match in Montreux. Being sad yesterday when Portugal couldn’t follow through and lost to France.

- Hanging out with Pan one day after I got locked out of the apartment, eating a yummilicious Greek salad at a cute bakery/chocolaterie, finding new cute places in Geneva, people watching on a park bench in Place Neuve
- Fondue at Home St. Pierre (I know, local Genevois, that fondue in summer is a no-no…it wasn’t my idea!), Harold being upset about Buffett donating all his $$ to the Gates Foundation (all power shouldn’t be concentrated in one place), eating a lot of salami

- My ‘special’ meeting with T, in which a certain girl F was not invited ;)

- Roxanne speaking every language to random hotel people in Cinque Terre. Hanging out at America, America with 15 year old kids flirting with each other over pool tables

- Brunch at Le Calamar with Thiru, Roxanne, Jen, and Kim. Terrible European service. Kim dying of hunger and thirst.

me, kim, roxanne, and jen


Golden Paradise Flying Cheesesteak.

- Gazosa and kir at Le Barge with Kim and Thiru, this cool trailer set up near the river that raises money for local charities.



- Diabolos (Limonade with Peach syrup) at Café Arts

- Neverending hunt for Lemon Soda (this stuff is da bomb, and has little pieces of lemon floating around in it and isn't too sweet. We only could find it in Italy and Switzerland bordering Italy)….being sad that limonade in Geneva=Sprite and that iced tea was never available (even though hot tea was)

v
enjoying lemon soda in cinque terre (i got everyone hooked)

- Flight home from Paris. Sitting next to a super Chinese dude who kept asking me about myself at the beginning of the trip and then after much prodding finally revealing that he was a professor at the medical school but did research in the field of tumor biology. Asking me if I knew that Michigan was a good med school and telling me its ranking. I was like uh, actually, our ranking fell last year, but I didn’t say it. Of course I know about the med school, I just spent the last three years of my life there.

- Ramseier (I probably spelled this wrong) carbonated apple drink from the German part of Switzerland

- Hanging out with Jen (sans a certain person we know).  Making last minute travel plans.

- Good coffee, but why is it in little cups?

- Yummy chocolate (although I didn’t have much of it)

- Cereal with strawberries, courtesy of Pan

- Kumar making fun of me saying, ‘Hi! What is going on? (you can insert any number of random questions here)’

- David Heymann telling me to finish residency. Harold telling me that it was necessary

Things I won’t miss about Geneva

- The price of food
- Everything closed on Sunday
- Everything closed at like 6 pm on weekdays
- French! (mostly because I don’t speak it). I like that lots of words end in ‘-erie’ though. Confiserie, chocolaterie, patisserie, etc.
- No air conditioning anywhere (what’s wrong with you people?! Near the end, I would go to work and sweat up a storm just sitting at the computer)
- Dirty looks from dirty men!
- The size of washing machines (I really did essentially all my laundry in one load when I got back to the US. Amazing!)
- Honking and/or screaming (aka general madness) post-World Cup matches until three in the morning

Last minute decisions...joining up with Harold and Kumar to go to Cinque Terre, Italy!

Weekend of June 24-25th, 2006

Although I had originally planned on making a weekend trip to Germany, the director of our program (who I will refer to as Harold) and another fellow, Kumar (also an alias, but the fellow is Indian) had decided to go to Cinque Terre for the weekend and invited me to come along. I’ve heard tons of people rave about Cinque Terre, a series of five towns built into the mountains on the Italian Riviera, so I signed on and also convinced my friend Jen to abandon her original travel plans to come along.

We decided to go to Cinque Terre on Friday afternoon without any train reservations or room bookings and planned to leave Saturday hella early in the morning. After a long day of class and visits to the US Mission to the UN (where I asked the Health Attache a pointed question about the US role in the firing of US national and WHO Representative to Thailand Bill Aldis) and the Drugs for Neglected Diseases Initiative, we booked it to the train station, bought a ticket for Harold, and reservations for myself, Kumar, and Jen. For some reason, Harold had to be separated from us and always had to sit by himself in the train – I think it had to do with bookings with Eurail passes. In any case, Kumar often went to check on Harold during the train ride while me and Jen hung out. The train ride was long (like 7 hrs) and we transferred in Milan. Since we had some extra time, we found a café near the train station there (which was really beautiful, btw) and I had a tomato and mozzarella panini with a yummilicious salad for lunch. After Milan, we had to catch a series of hot, un air conditioned trains with interesting signage (for example, there was a sign telling you not to throw bottles out of the window…or that’s how we interpreted it, at least). This interesting signage was to become a theme throughout our Cinque Terre journey.

When we finally arrived in the Cinque Terre area, we had the bright idea to try and catch a boat to our town (La Spezia), which was south of the five towns in Cinque Terre. This was a good idea since it was ridiculously hot in the trains. In town, I asked a couple sitting at a café for directions to the ferry and Harold questioned me on how I knew they spoke English…I dunno, I thought, you just have a feeling when you travel on who can help you and who can’t, and the guy (who was older) looked like he knew what we needed to know. Anyway, we ended up just barely missing the last boat out (there were only two a day or something ridiculous) and had to take the train to our hotel. After dropping our stuff off, we decided to start the hike between the five towns, and were able to make it through the first three towns (Riomaggiore, Manorola, and Corniglia) starting from the South before hopping a train to Monterosso for dinner.

Memorable moments from this hike included:

• Practicing the names of the five towns with Harold, and Kumar semi-giving up and just naming them A-E. I think Harold got the five town names by the end, but we were essentially chanting them throughout the trip.
• Kumar joking that there was no group of people he would rather hike ‘Lover’s Lane’ with than us (motley crew of Chinese American girl, Thai American girl, Indian dude, and Chinese American grown up dude)
• More random signage (no high heels allowed while hiking, and then some signs we had no comprehension of…ill try and get a pic to allow you all to come up with your own interepretations – something with fire, but it’s much more complicated than that)
  Climbing up 360+ stone stairs to get to the village of Corniglia. For some reason, this felt like corporal punishment because from the bottom, you can’t actually see that there are that many stairs. Harold vowing NEVER to climb the stairs again. Us realizing at the top that there is a shuttle bus to take you into town.
• Random DJ in Corniglia playing hip-hop in the town square (but then transitioning to soft rock, I think). Us noting that American music is everywhere. Me noting that I like to sing along.
• Harold freaking out about timetables and trains. Example: We went to the largest town, Monterosso, for dinner. It took us awhile to find the restaurant we wanted to eat at, and he kinda freaked out on the waiter because we had limited time (what can we order that will be done in less than 20 mins? We have to catch a train!) and on us (we have to leave now!). He would also freak out throughout the trip whenever we had to catch a train if we weren’t on the platform when the train came, and would start running towards it with his huge, mega-filled backpack.
• Kumar ordering fried shrimp. When they came out whole, he started just eating them before Jen intervened and showed him the expert peeling process. This took a long time, but the shrimp were super delish!
• Randomly running into a religious procession (on further research, I realized it was St. John the Baptist Day), which consisted of priests, a band, people balancing huge crucifixes with Jesus through a contraption that was made up of a belt with a large loop for the pole – for some reason they were not supposed to use their hands), children dressed up in religious costumes, and tons of lay people. Later on the night, there were also kickass fireworks in Monterosso that we watched from the train station back to La Spezia.
  
  
  harold, kumar, jen, and i on the first day of our hike in cinque terre
  
  

Day Two:

Jen and I beat Harold and Kumar out of bed and ate breakfast in the dining room downstairs. It was pretty yummy, and we each got a fresh pastry. I also tried to load up on carbs for the long hike ahead, so ate cereal, yogurt, and also had the obligatory coffee. Because we were catching the afternoon train back to Geneva, we ended up having to carry all our stuff on the hike for the second day. We decided to start our hike at Corniglia (the city with the stairs), assuming that the trail went around the side of the mountain instead of over it. Unfortunately, we were wrong and started the second day with (yes, you guessed it), climbing the 360+ stairs AGAIN, but this time with all our stuff. It ended up not being too bad, but it was just funny at the time.


overlooking vernazza

Highlights of DaY Two:

• Making fun of ourselves for being Asian and taking hella pictures
• Harold taking pictures of all kinds of plants and flowers (this is a continuation from Day One). Harold noting that he used to have a greenhouse/garden where he planted series of plants to show cross evolution, or something like that. (Example: all different types of lemon plants – lemon balm, lemongrass, lemon fruit). Me noting that all of us are true nerds in our hearts.
• Eating more gelato…Harold is obsessed with gelato and wanted to try every gelateria in sight. He almost did, I think. We had a variety of yummy cool drinks in towns while hiking though, including gelato frappes, fruit smoothies, and others.
  
  
  after lunch in vernazza
  
  
• Series of interesting conversations touching topics like race relations and dating, (lots of Asian women and white men being together, for example), why walls are important when living with others (Kumar noting that living with a bunch of other dudes in a loft was fun, but not fun when the walls did not go up to the ceiling, esp when girls were over. Harold noting that it would be hard to study if you could hear other people all the time. Us laughing, and Kumar ending the conversation by saying the main criteria he had for dating girls his senior year was that they had walls in their bedroom), how med school sucks, and more.
• Harold carrying a hella heavy backpack to go hiking (including his laptop, books, etc) and Kumar helping him by taking some of his stuff in the end.
• Lemon soda!
• Me getting hot and taking off my shorts to hike in my bikini boy shorts. Harold being a little shocked (but there were tons of women hiking in bikinis since they would just go down to the ‘beach’ or rock face, and go swimming). Harold noting that I was definitely not ashamed of anything (this is mostly true).
  
  me in my h&m bikini shorts in the middle of our hike from corniglia to vernazza
  
  
• Layover in Milan on the way back to Geneva. Taking the subway to the 3rd largest cathedral in the world, the Duomo. Jen and I being denied entry because we were wearing shorts (and I was wearing a tank top). Jen being sad that we couldn’t go in, and me deciding that we should just change in the square because we had all our stuff with us anyway. I went to a corner where they were doing construction and just took off my shorts (bikini shorts underneath) and pulled on some pants, and Jen gave me a tshirt to pull over. I convinced Jen (who is way more modest than me) to just pull a skirt she had over her shorts and then take her shorts off and pull on some jeans). This turned out to be more complicated than we thought, but it worked in the end. Harold being SHOCKED that we changed in the square. I think he thought we just stripped and put on all new clothing, lol!
  
  
  jen and kumar at dinner (notice the rizzoli bookstore behind them)
  
• Yummy dinner – sharing Asian style and eating risotto, rosemary grilled beef, penne arrabiatta, and greek salad at a restaurant in one of Milan’s famous malls/outdoor arcades.
  
  
  
  OK, that’s it! Jen or Kumar, you can add stuff to this list if you remember anything. All in all, I had a great time and was happy to spend it with Harold, Kumar, and Jen. I’ll post pics when Chris wakes up as well.