sustainable development

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

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!

Get Your Own!

Women's work

Yesterday was a good day even though I spent half of it hacking up a lung (I can’t imagine having smoker’s cough…I hate coughing!!) I didn’t do much in the morning but then got my act together and went to RIHES (the research institute where I work), had a long chat with L about various things, including birth control. A lot of women here don’t really know anything about birth control (even health professionals) because it’s kinda skimmed over in school and also because it’s culturally not acceptable to talk about stuff related to sex/family planning if you’re not married. Engaged doesn’t count. In lots of trials, women who are HIV+ have to agree to use some form of contraception, and we were talking about how it wasn’t really okay to say, ‘just buy anything and take it’ without proper counseling. Oral contraceptive pills are all over the counter here (as is most medicine…I saw Keflex for sale yesterday when I went to pick up azithromycin for my freaking amoxicillin-resistant strain of strep) and it comes with instructions, but I’m sure most people don’t read the insert.

The first time I had this conversation with L, I happened to get my period and not have anything on me, so I went downstairs to ask these two secretaries/admin personnel if they had a pad (tampons are also not popular here – I wonder if people think you lose your virginity if you use a tampon?) I could use. They did, but somehow the topic of birth control came up. One of the secretaries had heard it could help in the treatment of acne but she was scared to take it. Another told a story of her friend who started taking OCP’s before her marriage and got dizzy and nauseous. They had a ton of questions about it and felt comfortable asking me as a Thai-American, medical person, and also because I was married. I was thinking to myself, we should just do a private seminar for all these single women who want to know about this but don’t feel they’re in a position to ask about it because they’re not married (and likely not sexually active, as “good” and/or educated women). There are actually a great number of single career women here – I think a lot of them felt as if they had to decide between a career/education and a family (and/or sex life). Since they’ve made the career decision, they are celibate and they don’t date (or not to my knowledge anyway), which is sad. I’m not sure if this is their own choice or if Thai men are just too intimidated to date someone who is highly independent and educated (probably a bit of both). Sometimes I bring up the topic of sex/birth control but only if I know the women well (and never if men are around with a group of women) – I know the topic is taboo but want people to know that they can approach me if they want to know something and that I’m comfortable about talking about my own experiences/sharing my knowledge.

My Swattie friend Libby who’s on a Fogarty in India is actually trying to look at a similar issue (but from a different perspective) among HIV+ women in India. She states that there is a lot of social pressure for women to bear children there and wants to examine HIV+ women’s views on having children, family planning, etc. I think that that’s a super interesting question and wonder about possibly asking women (since we see a lot of them in the HIV clinic here) about their reproductive intentions, especially the younger women who don’t have any children yet and are often single or in a relationship (some of them are in serodiscordant relationships as well). With the MTCT (mother-to-child-transmission) rate being super low (<5%) style=""> (more on this later – I can’t believe I never finished my paper on that at WHO)

Anyway, back to my day yesterday. While waiting for Poo in the ID fellow room, I was able to write a five-page research proposal on the retrospective chart review we’re doing to compare cryptococcosis in immunocompromised vs immunocompetent patients. It was good to be productive again and also reminded me of college, where I would just sit down and write a paper and then print it out when it was done an hour a two later. Poo was impressed, but it wasn’t anything too difficult. After I was done writing, Poo and I hung out while waiting for P’Nui (Poo’s fiancée) to pick us up. He was late getting off of work, so we ended up chatting while Poo played Diner Dash (a heavily addictive game if you want to check it out). Poo tried to tell me I was an inspiration to her in Thai but I didn’t understand the word she was using. Luckily, she was able to translate it into conversational Thai (‘someone who makes someone feel like they can do more, and better’) as well as English. She said that previously she didn’t make a lot of plans or goals for herself in her life but after meeting me, she started thinking about what she wanted to do and where she wanted to go. It was really sweet! I’m happy that I can be a mentor to people regardless of where they are at in their lives. One thing I’ve learned for sure though is that you can make tons of plans, but sometimes life just has a different road map altogether for you – you definitely have to take things as they come. I think the best part about planning is being prepared for opportunities as they arise though…I’ve been lucky, sure, but I’ve also been prepared. I told Poo about a conversation I had with former Swarthmore IC director Anna Marie (does anyone reading this remember her?). She was generally useless, but I remember having this conversation with her when I was a first-year or a sophomore about thinking about where I wanted to be in five or ten years and thinking about my CV and what I wanted it to look like (or what I needed to do in order to get where I wanted to go). I’ve remembered that conversation until this day, and have really thought about long-term things I want to accomplish or things I’m interested in but haven’t had the chance to do yet (and how to go about getting $$ to fund me to do such things J ) So far, it’s worked pretty well. That being said, I don’t think life should be about your CV at all, but I think it’s your life experiences that can really make up your CV – what issues you choose to work on, who you choose to work with, how you choose to make a difference (even in your daily life). Even though I don’t have the most kickass boards scores (or grades in med school, for that matter), I’m happy about what I’ve accomplished in medical school, not just as a student, but as an activist (and a daughter, wife, and friend). In the long run, it really is true that no one remembers what your GPA looks like (even five years down the road)…thank god I don’t want to match in urology though. I wonder what my priorities would be then ;)

Judgment

Talking with Poo about how other people wonder why she’s an ID (HIV) doc. A lot of other docs (or people in general will say), "those ppl did it to themselves; why should you help them?". She says she’s sorry for the stay-at-home housewives who never did anything wrong and got infected from their husbands. She is not sorry for the men who got it by sleeping around/going to sex workers. I tried to express that it shouldn’t really be a matter of whose fault it is or assigning blame to people, but I understand about the women issue. Like should people be treated differently because they are thought to deserve something? Smokers and lung cancer? IV drug users and HIV? Although I agree people should take responsibility for their lives, I also think it’s necessary for us to think about humans as humans and maybe not be so focused on assigning blame. Who should be allowed to receive treatment when there are limited resources? It used to be Thai policy that active drug users could not receive ARV from the government...is that fair? Who decides how much people's lives are worth? Unfortunately we do make these judgments everyday. Drug companies make these judgments, American foreign policy makes these judgments, and we, as physicians, will make these judgments. I think that's been a hard thing for me to come to terms with. People with crappy insurance don't deserve crappy care but sometimes that's all you can give them because that's what they can afford.

I remember a conversation I had with my mom about assigning blame when I originally started working with HIV+ people. She held the belief that people must have done something to get it (and they shouldn’t be doing that stuff anyway, so they ‘deserve’ it). What about the women who get it from their husbands? (well, she replied, someone is doing something wrong in any case - he shouldn't be cheating on his wife). Not so black and white though. Even when thinking about my own life, it's hard for me to think that anyone deserves to be infected just because they have sex, esp. since I’ve engaged in a lot of risky behaviorin the past and was just lucky that I wasn’t exposed since I grew up in a low prevalence area. If you're going to assign blame and talk about victimization and fault, exactly how are you going to break all these people in to groups of no culpability (victim?), kinda responsible for getting infected, responsible for infecting others, etc? What do you tell the girl who slept with her fiancee who was infected and then became positive herself? (She found out when her fiancee, 22, died). How much blame do you assign an iv drug user who grew up in the slums and originally started using drugs to escape poverty, the miserable reality of life? What about the sex worker who is trying to raise money to send back to her family? Are all of us who engaged in premarital sex wrong? Do we all deserve std’s and a death sentence if we don’t get access to drugs? Do you personally still know any virgins? What if you were infected by your first partner and ended up infecting others, not getting sick until 10 years later? How many of you have been tested in the past?

I've been more aware of lots of subtle kinds of judgment, discrimination, stigma, lately. I'm taking private Thai lessons, and during my last lesson, my teacher brought this book called ‘ a day in a life’, which is collection of short stories about different people in thai society. Yesterday I read a story about this kid who lived with his alcoholic father. He had this piggy bank that he talked to everyday and put money in because he was saving money for new shoes. All the kids at school made fun of him because he was poor and had crappy shoes and his teacher was like, you should tell your dad to buy you new shoes, but he knew that his dad wasn’t going to buy him anything so he just kept saving. He also did really good things like donate money to his friend whose house burned down and he also found 200 baht but returned it to the owner (and got a 50 baht prize). At the end of the story, the kid’s dad broke his piggy bank when he was drunk and took all his money to buy alcohol. The kid bought a new piggy bank and then the whole story started over.

After reading the story, my teacher will ask me questions to see if I understood what I read (usually about the characters in the story). What kind of person do you think the narrator is? What about his father? She wanted to me to say his father was a bad person (and he didn’t really sound like a good father) but I didn’t want to get into the ‘all alcoholics are bad people.’ She was like, there are a lot of Thai people (mostly men) who are alcoholics…people should help themselves…why cant people just quit? My teacher talked about how there wasn't AA in Thailand, how she had a friend who quit once, and had respect for people who quit, but she really believed it was just a choice to drink a lot of alcohol (and then become alcoholic). I tried to bring the shades of gray into the conversation and brought up things like genetics, family, support, circumstances….I think that's a big thing I've learned over the years working with the underserved both at home and abroad...everything is some shade of gray, and I'm totally wary of people who just want to judge people in a black/white fashion. I'm wary of it in myself as well.

Finally, I never fail to be surprised at racist comments that my own (extended) family make (“I hate when the Burmese beg for money in the street.” “I refused to learn Spanish because I hate the Mexicans.”) What’s up with that? I try not to listen because arguing is futile (and disrespectful over here). Interesting to think about Race vs nationality – people are more into hating on other nationalites here (no 'Asian' bond exists). Why do people always have to look down on others/pass judgment? Are they making themselves feel better in some way?

ok, i havent updated in forever (again)

i hate when i get behind on blogging but sometimes just feel overwhelmed after a few days have passed and i feel like i have to catch up. however, i just thought about it and it's my blog, so i really can do whatever i want. i was pushed to update by bryan though, so here i am on saturday looking at my little book where i record what i do everyday and trying to figure out some themes to write about that might be interesting.

Food:

food is always a good place to start. ive had some fantastic food over the past few weeks. last night, poo,p'nui and i went to the Chiang Mai Food Festival. This yearly event lasts for a week and is roughly equivalent to a Thai County Fair, complete with a stage (there was a traditional Thai music/dance competititon last night), games, rides, and of course, food. I think there were maybe 30-40 food stalls there from famous restaurants in CM selling really yummy Thai food for very little money. We had two whole fish prepared in different ways (one with peppers and herbs that was broiled and the other that was grilled and covered with salt), yum woonsen (a sour/spicy noodle salad with seafood), sweet pork jerky, and more. p'nui and i also drank a pitcher of singha beer and i turned really red (surprise, surprise) but wasnt really drunk. after eating, poo played a bunch of the games that they had there and was able to shoot a stuffed animal to win a prize. it was kinda funny - all these guys were watching her load this wooden gun and shoot because she was all dressed up and is really little. when she won her prize, they were all like, we want to play too! but none of them won anything. lol.

other food ive been eating lately includes khao soi (this noodle/curry dish famous in Northern Thailand), young bamboo shoot soup, beef curry, Chinese pork dumplings, Chinese scrambled egg with tomato (best hangover food ever! i used to eat this after partying all night in Beijing and found out they sell it downstairs in the Taiwanese restaurant for $1), different kinds of yum (spicy salad), toast with butter/sugar or sankaya (this Thai spread), and more...i love Thailand, especially for the food. :)

Bangkok:
last weekend i went to Bangkok and got to meet up with a bunch of friends and see my uncle and aunt. since everything revolves around food here, these are the meals i had there:

friday night: dinner at the nai lert park buffet with poo, p'nui, and two ppl who picked us up from the airport. (poo had to go to an ID fellows meeting in Bangkok and was staying at the hotel across the street from my uncle's apt, so i just tagged along for the ride)

sat: i had two dinners - one with sarah and ken, who were in thailand for their honeymoon, and then again at this resort in nonthaburi where i sang lots of karaoke and ate leftovers with nan, krit, and about twenty other girls.

sun: brunch at kuppa with amalee and some of her friends (celebrating her bday!) - i just had bread pudding though, and then real lunch with my aunt and uncle at MK (sukiyaki), dinner at the airport with p'nui

work:

work has been really picking up lately. poo and i are working hardcore on our crypto study since she's leaving for a course in bangkok in two weeks and will be gone for two months. i have come to greatly appreciate the electronic medical record since charts here are basically pieces of paper stapled together and are hard to get info out of. will update more re: this project later.

i had a bit of a run-in with hopkins ppl re: this interview project i had planned to help out on with iv drug users. this will be the subject of a separate post (the next one) because i actually have to go work on that project now. i know this wasn't the most exciting blog, but it's a start...just trying to get back into the swing of things again. :)

fun times

ok, so this post ended up being deleted when i tried to publish it...not so fun. in any case, this post was about fun things i've done in the past few days. i wrote it after reading a bunch of dense articles on quality of life and statistics (can somebody explain cronbach's alpha to me?) ...anyway, here's a snapshot into my quality of life lately :) besides the post being deleted, i feel like it's been improving as time goes on...

fun friends:

i try to hang out once a week with my next door neighbor/landlady chi. last week we got a massage at this women's prison which was cheap (120 baht for an hr) and one of the best massages ive gotten in chiang mai! my masseuse was nice and we had a cool conversation touching subjects like learning massage, how the women who work there get paid, where we were from, etc. the program they have at this prison seems pretty cool - the women get to choose if they want to enter a vocational program and there's a salon, a massage room, and a store that sells items that the women make (embroidered pillows, tablecloths, etc). i wonder how many women pursue the professions they learn in prison after they get out.

after the massage, chi and i ran a bunch of errands (including eating noodle soup with homemade fishballs, picking up belgian chocolate, pork filled chinese buns (baozi!), and going to the bank) before picking up her daughter at international school. it was cool to see the school grounds and be surrounded with kids from five to eighteen getting out of school and kinda weird in a way - i havent thought about being back in secondary school forever. anyway, in front of the first grade classroom, two girls approached me. one said, 'who are you?' and the other said, 'i know, she's a mom. are you a mom?' and i laughed and said no, i was the friend of a mom there. this short conversation reminded me that little kids just see other people as kids vs. grown ups and also that i could be a mom at my age. even more surprising, i think i am looking forward to being a mom....i just dont think im going to be able to pick up my kid from school though :(

aside from hanging out with chi, ive met a new friend through karyn. when we met, we actually realized that we'd met at the International AIDS Conference in Bangkok two years ago since we both were doing work related to IVDU's. anyway, her name is maddie, she's british, and she's been living in chiang mai for the past four years. she also has a thai bf who does work with ivdu's and who id met before in bangkok. we met for coffee and then she took me to the harm reduction center here where i'm going to try and hang out. i was kinda dressed up since i had to give a journal club talk on cryptococcosis in immunocompetent pts in the afternoon and they were nice (but kinda wary) of my presence, which was totally understandable. cool thing is that the house isnt located too far from my apt and i think i can really help out just talking about HIV/AIDS, ARV, coinfection with Hep C, etc. right now they're going through some restructuring and there's a retreat this weekend, but maddie and i are going to try and think of some ways that i can help out, so im excited to get involved with the community.

in my own condo community, i hung out with the ramen shop owners mai and his brother one night last week when it was pouring and i was too lazy to venture out for food. i was on the only customer in the shop and they gave me free beer and we talked about different things, including the effect of smoking on health, hip-hop, motorcycles, and why I didn't speak Thai perfectly. i was really surprised to find out how little mai knew about smoking (besides that it was 'bad' - he asked what effect smoking had on his lungs, if it affected anything else, etc.). when they asked me about seeing hiv patients, i talked a little about hiv and was like, safe sex is really important, y'all should wear condoms whenever you have sex. this was followed by awkward silence but im serious. girls arent supposed to talk about this stuff, but i feel like im in a unique position and they are just like, oh, she's a crazy american....oh wait, american policymakers are totally all about abstinence and not giving people any sex education. blast!

finally, i dragged poo and nui to this free concert hosted by the US embassy and consulate in Chiang Mai and CMU's Faculty of Fine Arts in celebration of HM's (his Majesty's) 60th anniversary on the throne. the concert featured the New Orleans All Star Brass Band, made up of three generations of jazz performers, and it was awesome! the venue was a little terrible though (huge convention center with horrible acoustics) and it was a lot of Thai people's first experience with jazz, so they weren't totally comfortable clapping along or dancing, which the performers really encouraged. p'nui and i danced though :) and i think they thought it was interesting. cultural exchange in action. after the concert, i hung out with ben and his friend at the drunken flower, a local pub/restaurant that is frequented by the NGO community and cool farang. i liked the atmosphere but didnt drink anything...i just have no tolerance these days and dont like riding home alone when i dont feel well. i think things'll be much better when i have a motorbike though...

fun food updates:

last night vit took me to eat my first shan meal, so im expanding my culinary horizons. the restaurant was on the second floor of this house and well decorated - it was open with bamboo poles and woven mats for the roof (the owner built everything himself), and the lamps were upside down containers used to hold sticky rice at the market. ill have to take a pic next time i go there. anyway, it was really cool because the house was surrounded by trees and vines and it was just like hanging out in a house. the food was great, and vit told me before we got there that there wasn't a set menu - you just show up, the owner tells you, 'i recommend these two or three dishes today,' and then he tells you what they are and you agree. last night we had stir fried tofu with green beans and peppers, this soup with onions and dried fruit (a little sour, only eaten in southern china/northern burma), and pork with peppers and this yummy sauce. i also tried shan tea (a little bitter, and black) and learned some shan words with vit and the owner. it was very chill, and we even got a sneak preview of the gallery they're opening on the first floor with burmese paintings done by a shan artist who i think also lives in the house.

work is going well too...but that's not the subject of the post. :) more pics to come soon!

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.