when it rains, it pours

it's not really raining in chiang mai, but i think it sums up how i've felt the past week. of course, visitors/guests/PI's must all come in droves, so here's a quick rundown of who ive hung out with for the past eight days:

thursday (3/15) - met with porn at empower. she's one of the managers/head honchos at the chiang mai empower, located in a roomy house with lots of common areas for cooking, eating, watching tv, using computers, etc. we had a long chat about empower, sex workers, the programs and outreach that are offered at the center, research among sex workers, etc. i was disappointed to find out that they didn't accept any volunteers for a time period shorter than three months and wished that i had visited earlier (doh!). in any case, i got to hear about some cool projects they run including a day/night care center for children of CSW's and 'Friday clinic', where a local public health doc and nurse come do STI testing at Empower. overall, the CM center seems to be less structured than the BKK center (at least when i volunteered there in 2002-2003) and more like a home away from home for a lot of women.

friday (3/16) - AHRN (Asian Harm Reduction Network) held their annual weeklong (?) workshop and this was responsible for bringing many people to chiang mai. on friday, karyn (good friend and executive director of TTAG, Thai AIDS Treatment Action Group) arrived so we (chris, karyn, and i ) met up for dinner. every time karyn comes to chiang mai, she visits the 'Ancient House', a restaurant housed in this 180 year old teak mansion built in the traditional Thai style. it's pretty cool because you can get your own room, sit on traditional triangle pillows on the floor, and there's some kickass northern thai food. our pick for the night was definitely this hors d'eouvres/set thing we got, featured in the picture. this included fried sour sausage balls, northern thai traditional sausage, nam prik noom (this green chili dip made with peppers and eggplant), thai vegetable soup/curry, and laab moo (minced pork 'salad'). after dinner, we met up with brigitte, an australian and a current project coordinator with TNP+ (Thai Network of People Living with HIV/AIDS), and had some good conversation re: what's going on with TNP+ now and what people were thinking about doing with Abbott.

Brigitte and Karyn noted that a huge problem was that thai civil society was super kickass and strong but that a challenge was that people really couldn't speak English/communicate with foreigners without a translator/facilitator that could help with the language barrier. also, a lot of the civil society groups (including ones that participated in the mass movement and protests around the US-FTA talks) had their true bases among the people (farmers, laborers, etc). for example, TNP+ has very few members (if any) that can speak English at all because many PLWHA's who are more educated or in a position of 'higher' social status feel that membership within TNP+ is in Thai ('chuay'), which can be loosely translated as 'ghetto.' i really feel that it is amazing that such broad coalitions have been formed (and continue to exist) across thai civil society though - for the abbott protests that are happening now, many NGO's (not directly related to HIV/AIDS) have come out in support and it's great to see that people are starting to recognize that HIV/AIDS isn't just a disease/health problem but actually about poverty, inequality, and a host of other factors. laura, current Global AIDS Fellow (GAF) at AMSA, also brought this point up when she talked about how some board members in AMSA felt like we (as an org) were just cutting AIDS when they were talking about eliminating the position this year. (thankfully, her and many others worked to save it!)

saturday (3/17) - gig invited us to this organic food festival/seminar for local farmers at jj market in chiang mai. we went around 10 am, hung out at gig's booth (i think he was volunteering for a friend's org?) where they displayed all the varieties of indigenous rice in Thailand, gave out information about genetically modified organisms/rice (which they are against), and had a petition to sign. Cloth and other products made from organic cotton was also available for purchase at the booth. Many farmers were at the event and came dressed in traditional wear. i noted that many of the young women were wearing white dresses and my friend told me that this signified that they were unmarried - i wonder if the guys had a similar designation, but it didn't seem like it. the highlight of the food fest was (unsurprisingly) the food. for 99 baht, you were able to eat unlimited samples of northern thai food, distributed at little straw huts around a courtyard. highlights included: khao soi (noodles with coconut-milk based curry), khanom cheen (rice noodles also served with northern style sauce), khao haw puk (rice noodle/crepe stuffed with organic vegetables), and more. unfortunately, chris and i had to leave early because i had a meeting with a JHU prof that was visiting and one of the PI's i work with here re: the QOL (quality of life) paper that i'm helping to write.

saturday (3/17) - tuesday (3/20) - nonstop meetings with Dr. Suwat (MD/PHD PI here who does tons of community-based, behavioral intervention trials) and JHU prof, Dr. Albert Wu (AW). AW is awesome since he was one of the main people to design/create the most-widely used tools to measure HIV-related QOL, the MOS-HIV. even more awesome, he is really down-to-earth and super supportive re: students. chris, myself, and i went to mo'c mo'l with him for dinner and he gave me some good advice regarding residencies & career plans. i am trying to finish the paper im working on (discussing the translation process of the MOS-HIV and another non-specific QOL tool, the SF-12, into Thai and their reliability and validity when administered to 100 PLWHA's on HAART in Thailand) in the next few weeks so that it can be sent off to QOL journals by the time i head back to the US. i'm also excited to (maybe) be a part of the team here that is going to write a series of papers on data from this trial that has been going on for the past three years looking at the impact of HIV+ peer educators and special training for HIV docs/nurses on dropout rate, adherence, risk behavior, and more among almost 800 PLWHA's on HAART in Northern Thailand. This trial was HUGE and involved 45 community-based hospitals throughout Northern Thailand; funding was provided by Horizons/the Population Council and MEASURE. Reps from all the hospitals were at the dissemination meeting held on Monday at a local hotel (hence the nonstop meetings beforehand to go over presentations, data, etc). and afterwards (debriefing). more on this QOl stuff later.
bottom line: yay for profs who care about students!

tuesday (3/20) - i skipped out of lunch with dr. suwat and dr. albert since i had a prior commitment with lara, the head of ethics/irb at RIHES. she treated me to this awesome lunch at jerusalem garden, where we had meze (a platter with hummus, baba ghanouj, tzatiki, tabouli, fried cheese, and more) and talked about my PP project (she helped give suggestions on the thai version of my questionnaire), her fam, my fam, and RIHES. good times - she's definitely been a huge support to me while i've been in Chiang Mai.

wednesday (3/21) - after teaching at m-plus (where i talked about gender roles and expectations in Thailand and the US), i hung out with some of my students while waiting for chris to pick me up. they invited me to come check out Project HOPE, the NGO where they all work, nearby and said they had some interesting TB projects going on. i enjoyed the class and got some interesting perspectives about why people delay marriage (or just don't get married) here, including that many jobs will only take women who are unmarried ('Miss').

after chris picked me up, we headed over to the night bazaar area (which we both hate) to meet up with brigitte from TNP+ and laura frye (AMSA GAF). brigitte and i met up first and she gave me some materials from TNP+, including a brochure that featured pics from the 2004 Bangkok International AIDS Conference on the cover. I positively identified my profile holding up a banner stating 'Say NO to Bush's Toxic Trade Deals. Break the patents, Treat the People!' good times.

laura joined us a little later and we talked about the whold abbott thing and TNP+ before brigitte had to bail and catch her flight back to bangkok. chris and i were starving by that point and dragged laura to fuji with us so we could grab something to eat. laura updated me on AMSA goings-on and i gave her some info about my Fogarty experience here. i haven't had much of an opportunity to spend time with Laura in the past, so it was nice to connect (in all places, Chiang Mai) and feel somewhat back-in-the-AMSA-loop again.

thursday (3/22) - poo (ID fellow) called a few days earlier and told me to come meet her on Thursday since she's now back from meetings in Singapore. i joined her in clinic, where i saw many patients i had seen before (including two older women with the unknown CMI (cell-mediated-immunity) defects, a guy who had gone blind from CMV retinitis, and an older Caucasian man with his young (deaf) Thai partner. The older man noted that he had read about me on the Internet (he must have googled me), which was a little weird.

I also saw an interesting case (now recovered) of disseminated penicilliosis/salmonella sepsis. Because Poo was busy, the patient and I got to talk a little about his history. He hadn't been treated before his sepsis even though he had known of his diagnosis for almost ten years, and interestingly said that he thought he contracted the virus either in moscow or thailand. finally, he said his wife (also +) just gave birth to their child a little over a week ago and was sterilized immediately afterwards...i didn't get to talk that much about reproductive intentions, but wish there was more time to explore this in clinic (maybe the nurses talk about it; i have no idea, but docs definitely don't touch on family issues...this is partially secondary to time restraints, but i think it's also in their training to just focus on medical problems and not other things).

afternoon - rounds with dr. thira and the ID team. lots of interesting cases to report here, including sepsis secondary to Strep suis (from pigs), and still pretty rare worldwide, but first reported in SE Asia, idiopathic CD4 lymphopenia complicated by CMV esophagitis, axial osteoarthritis (sterno-clavicular joint) in a non-IVDU growing gram-negative coccobacilli, the most horrendous case of b/l mastitis i have ever seen, and a possible ethambutol-induced drug rash (pt was treated for tuberculous joints and not pulmonary TB). i also met the visiting med/peds resident from minnesota who was rounding with the ID team, patrick.

poo also gave me this QOL study report that the head HIV nurse had put together and asked if i could maybe write something up with it since the crypto chart review is proving to be more difficult than expected (charts/medical records are kinda a mess here). poo is adamant about pushing on though and i think is getting a resident/med student to assist with data collection. right now, i'm supposed to try to read through this 50-page Thai report and see if i can do something to it/write it up in English.

at night, i went to dinner at MK with Aum & Gig and Aum's good friend Ann (married to Narin a few weeks ago)... chris couldn't join us because he was completing yet another interview online but came out briefly for bud's ice cream afterwards. in any case, my medical knowledge came in handy when ann asked about some advice re: conceiving after a procedure. we also had good times talking about aum back in her nursing school days. aum is leaving for bangkok and her new nursing job at bangkok hospital next week! :(

ok, that's enough for now! chris and i are off to luang prabang, laos for a few days since chris's visa is expiring this weekend.

ps CONGRATS to everyone who matched!! im excited to see you all as bona fide docs in a few weeks :)

announcements, air pollution, and abbott

1) there was a post up about performing abortions that i took down on advice from a good friend. if you're interested in reading it, please send me an email or IM - i'd love to hear people's comments. thank you to everyone who has read/commented/helped me process so far.

2) I won the Global Health Action Committee (GHAC) Chair election in absentia at the AMSA National Conference in DC this past weekend :) i've definitely missed AMSA and am really looking forward to working with next year's leadership (esp all the GHAC coordinators and all GHAC peeps) in advancing global health action and advocacy.

3) Due to fires in Burma, Laos, and Thailand (both forest and those set by farmers who burn rubbish and/or practice slash & burn techniques) , the air quality in Chiang Mai has deteriorated considerably with decreased visibility and increased smog. Apparently the carbon particles in the air are more than twice the acceptable limit. Public health officials have encouraged immuncompromised & elderly to stay indoors if possible. Chris and i recently joined the ranks of those wearing masks whenever we venture outside.

4) There is a media war right now in the Asia edition of the Wall Street Journal regarding Thailand's issuance of a compulsory license on Abbott's Kaletra (liponavir/ritonavir), a common second-line HIV/AIDS drug (also used first-line in the US) with tons of back-and-forth among those supporting vs those hating on Thailand. There was a super inflammatory editorial titled 'Bangkok's Drug War Goes Global' in the March 7th edition of WSJ-Asia, and then lots of letters following. In any case, here's some quick background with all acronyms explained:

The Thai MOPH (Ministry of Public Health) announced that they were issuing a compulsory license (CL) for this drug a few months ago. For those not familiar with intellectual property/patent issues, this means that Thailand is going to make its own generic version of Liponavir/ritonavir using GPO (government pharmaceutical organization) facilities. Compulsory licenses allow countries to either manufacture their own generic versions of drugs currently under patent or to import generic versions from a country who wishes to sell. The rationale behind issuing a compulsory license, which is perfectly legal under current WTO (World Trade Org) trade agreements (Article 31, TRIPS - Trade Related Aspects of Intellectual Property agreement) is to dramatically lower the cost of the drug so that it can be accessible to more people in that country. A compulsory license is used for a specified amount of time and a royalty is given to the patent owner (in this case, Abbott).

In 2005, Brazil also announced that they would issue a compulsory license for Kaletra and produce their own version of the drug. However, this never came to fruition because the Brazilian government and Abbott agreed on a special reduced price for a certain number of years in exchange for Brazil withdrawing its compulsory license. Thailand also entered negotiations with Abbott after the Kaletra CL was announced, but the Minister of Public Health determined that Abbott's offered reduced price was not sufficient enough and Thailand is going forward with the Kaletra CL (the government is currently in process of importing Kaletra from an Indian generic company, Hetero - I assume this is to cover until GPO can get its own production going).

Abbott is PISSED OFF about this and announced yesterday that it will:

1) Refuse to register any new pharmaceutical products in Thailand AND
2) Withdraw any pending applications for registration

until Thailand changes its position (basically, until Thailand withdraws its Kaletra CL).

This is UNPRECEDENTED and means that no new Abbott products will be allowed to enter the Thai market. One registration that is being pulled is the heat-stable version of Kaletra, rarely accessible in the Global South. The entry of this drug would be huge, as the current version of Kaletra requires refrigeration (which is obviously difficult in tropical settings/rural areas/areas without constant electricity). Abbott has previously been criticized for not registering or making this drug accessible in countries where it is likely needed the most. By pulling the registration for heat-stable Kaletra (among other drugs, including those to treat heart disease and other general conditions), Abbott is sending a strong message to the 580,000 people living with HIV/AIDS in Thailand - as well as to the other governments considering issuing compulsory licenses in the future.

As messed up as it seems, pharmaceutical companies have a total monopoly on where they choose to register their medicines. Registration (for US people) is the equivalent of submitting your drug to the FDA for approval. If you don't submit it to the FDA, it can obviously never be approved/sold in the US. Same goes for other countries. If Abbott refuses to register drugs in Thailand, those drugs CANNOT be approved/sold here which obviously restricts access for not only new HIV/AIDS second-line drugs, but all sorts of drugs in general. The Thai Network of People Living with AIDS (TNP+) protested in front of Abbott offices at 1 pm today. i really wish i was in Bangkok at times like these.

on a semi-work related front, the head of the ethics/regulatory compliance office at RIHES invited me to give a talk to all the study coordinators (heads) at RIHES about these same issues (compulsory licensing, TRIPS, etc). she's a good (american) friend here and has helped me with some of the IRB stuff i'm working on for my demographics study on women who receive abortions here. she noted that tons of people had recently been coming to her with questions and she didn't know so much about it, so she decided to bring in me instead.

i also submitted an abstract last month about these Kaletra CLs in Brazil and Thailand last month to the American Public Health Association national meeting, building on some of the preliminary research I did at the WHO this past summer. Guess all this IP knowledge does come in handy sometimes :)

volunteering & international women's day

today was international women's day! there wasn't much celebration in chiang mai but karyn had tipped me off to a march/cultural show/celebration at Thapae Gate sponsored mainly by Empower Foundation, an NGO for mostly women CSW's where i volunteered teaching english during my year in bangkok. there's an office in chiang mai and it focuses on migrant issues as well as many of the Shan (and others) fleeing Burma become involved in sex work as they don't have many other options as stateless and undocumented people. this year's theme for the local international women's day was therefore fittingly named 'women in transit.' chris and i missed the march but enjoyed some acts of the show, including a Thai man who sang and played a Karen harp, and a Norwegian woman (who works on the border and speaks fluent Shan) singing both English and Shan songs she had written herself about the political situation in Burma. all the Burmese women in the audience waved rolled up pieces of paper and use them like lighters, waving them back and forth in the air. it reminded me of anti-war songs and rallies in the us, but smaller, and more intimate.

at the show, there was also a pick up truck housing an art exhibition called 'Labour sans Frontieres', a collection of handmade paper maiche dolls made by migrant women. The dolls, or 'kumjings', are meant to bring attention to the issues facing migrant women in Thailand and also convey their hopes and dreams. Each doll has a 'passport' written by its creator detailing where she has been and where she would like to go. So far, the kumjings have traveled within Thailand and to many countries abroad, including Singapore, Canada, Spain, Japan, Cambodia, Korea, Austria, Sweden, and many more! For more info on the project, just click on the Empower link I posted above.

i haven't been into empower in chiang mai, but have meant to go for months. i got their contact info from one of the mc's at the gathering today, so hopefully i will go and visit next week! maybe i will check out volunteering opps there as well, although it is a little late...and i just started volunteering at another NGO, m-plus. read more below:

since i was in maehongson last week, i didn't go to ben's first meeting with people from m-plus (this NGO directed at gay/transgendered men and male commercial sex workers, or CSW's) where we had volunteered to teach english for the next two months. instead, i joined him for the first formal class last night.

i was expecting the class to be made up of m-plus clients, much like the women i taught at empower. instead, it was a mix of men and women, mostly from an NGO a few doors down called Project HOPE that focuses on HIV/AIDS education and prevention. from what i gathered, m-plus and Project HOPE collaborate a lot. there was also a fourteen year old transgendered MTF (male-to-female) who has a HUGE crush on Ben (but he is convinced that Ben is Japanese).

it's been awhile since i taught English (and it was Ben's first time) but as Ben had told me, the English proficiency of the students in our class is surprisingly high. It seems like a lot of them have college educations and we have some recent college grads in our class. One of the outreach directors of m-plus also sat in and participated in the class (I think he also wanted to check out if we were legit or not - he said we passed the test after class was over). :) For the first class, Ben and I focused on introductions and then months/days of the weeks/seasons and other measurements of time. after class, some of the women approached me and asked why i spoke such great Thai (rare compliment to hear in Thailand if you're Thai-American). i chatted with them for a bit and expect to become better acquainted with them in the next few weeks. :)

magha puja day & more in bangkok

chris, bryan, and i took a flight down to bangkok friday so that can bryan could spend a few days in the city before heading back to nyc. since we got back to my uncle's apt around 630 pm, we decided to drop off our stuff and head directly over to siam square to catch dinner and a movie. the skytrain to siam was packed (friday night, beginning of holiday weekend). fortunately, we all survived and watched dream girls, browsed the food court at paragon, and ate pizza hut after the movie got out since everything else was closing. i also got to browse the goods (clothes, purses, shoes, jewelry) that hawkers were selling on sheets they had laid out on the street in siam square and realized that i really miss that aspect of life in chiang mai.

we all really enjoyed the movie, but bryan noted that he didn't like when the actors/actresses broke out in song when they were supposed to just be having a conversation. i replied with, 'that's what happens in musicals!' bryan's response: 'but this was a movie trying to be a musical, not a musical trying to be a movie.' we all have our own opinions. :)

the next day (saturday) was magha puja day. this is a major buddhist holiday and commemorates the day when 1250 arahants (enlightened people) assembled spontaneously to hear the Buddha give one of his famous sermons discussing the fundamentals of Buddhism (avoid doing bad, do good, purify the mind). this day is also important because the Buddha had personally ordained all the 1250 arahants himself. during Buddhist holidays, people try to make merit by going to the temple, giving donations, and also buying flowers, incense, and candles for 'wian tian', or a ceremony where you walk around a temple's main hall three times (for the Buddha, the Dharma (teachings of the Buddha), and the Sangha (those who follow the teachings of the Buddha).

bryan, chris, and i spent the day touring wats, or temples, in Bangkok. we got off to kinda a late start because i had to go to my mom's seamstress/tailor and have my measurements taken first since my mom wanted me to get a suit made for residency interviews later this fall. the seamstress was really nice and said, 'I totally expected you to be super huge the way your mom was talking about you! She said you were as big as an elephant, but I think you're still nalaak (cute, good) and not fat.' i was kinda mad at my mom for saying that to her but also relieved that she wasn't going to talk to me about how fat i was (common theme in Thai culture). the measurements didn't take very long and the shop was conveniently located across from playground! (a concept store on soi thonglor), so we stopped in for lunch at vanilla cafe. highlights of our meal included: cherry coke (with the syrup given to you separately to mix in), bacon and apple salad with this super yummy dressing, and warm sunken chocolate cake with ice cream. i had my standard grilled salmon with linguine pesto, and chris had a huge pork chop with spiced apple and raisin topping. bryan had pasta (rigatoni with italian sausage) as well. after exploring playground! for a little bit and checking out their art gallery space, we hopped in a taxi and braved bangkok traffic for quite a long time before arriving at Wat Phra Kaew (The Temple of the Emerald Buddha) and The Grand Palace.

It was super hot by the time we arrived at the temple (noonish) and there were a lot of people (especially Thais) there to celebrate the holiday. The shrine/hall where the Emerald Buddha was kept was closed off to the public and the surrounding area was filled with Thai people, many dressed in all white, chanting. we were able to explore the rest of the temple/palace grounds though. one highlight of the Grand Palace was seeing the Changing of the Guard, which i imagine is much like the same ceremony at Buckingham Palace. after our tour of Wat Phra Kaew, we stopped by the pier market for some refreshments and walked a few blocks over to Wat Po (the Temple of the Reclining Buddha and the site of the first university in Thailand). At Wat Po, bryan made merit and attached gold leaf to the Saturday Buddha (there are Buddhas in different positions - walking, sitting, standing, etc, for each day of one's birth - more on this in the mae hong son post below).


chris and bryan also got their fortunes told by local Thai fortune-tellers at the temple who use a mix of numerology, astrology, and palm reading to discuss your personality, work, and life. i was the scribe during this time and also helped translate. i don't feel at liberty to disclose others' fortunes, but i will say that the first thing the fortune teller told chris when he sat down was, 'this boy is really attached to his mother - he is a mama's boy!' this was really funny to me as its a long-standing joke between me and chris (and exactly what his cousin tony told me the first time we met).



after fortunes, we boarded a super packed boat to Siriraj Hospital, where Nan was waiting for us. While we waited for other people to show up, we sipped cold drinks at a thankfully air conditioned Black Canyon at the pier. Later, we walked to another local wat for wian tian before heading to dinner at Studio 9, which was celebrating its grand opening. Nan had luckily reserved the last table earlier in the week for our party, which included my close Bangkok Thai friends (nan, mon, krit), nan's friend may, and chris, bryan, and myself. Studio 9 is part of Patravadi Theater, an open air playhouse/restaurant featuring performances that blend classical Thai traditions with more modern art forms. we didn't stay for the entire show due to the overwhelming heat, but saw pieces featuring acrobatics, khon (masked drama), candle dancing (Thai classical dancing where women carry two lit candles in their hands while dancing), musical fusion (using Thai classical instruments to play modern songs with a band), and more. i had a good time even though we had the worst seats in the house and would like to go back on a cooler night in the future. i urge anyone going to bangkok to check it out as well.

after the show, we wanted to go sing karaoke but everyone was too hot and/or tired to go on, so we parted ways and ended up at home. because no one is allowed to sell alcohol on Buddhist holidays, we figured that a lot of establishments might be closed as well. in any case, we got to hang out with my cousin Ted (visiting from Irvine, CA) and talk to my mom and my aunt on Skype. kinda like a mini family reunion, which always entails funny stories about the past and people making fun of each other (in a joking way) on my mom's side of the family. we ended up going to bed close to 2 am and i attempted to see the full lunar eclipse from my uncle's balcony but wasn't able to see the moon.

today ted and my uncle likhit left for phuket to visit my uncle chin (and go scuba diving). we're planning to go to asia's largest open air market (jatujak weekend market), maybe sing some karaoke, and grab dinner at mon's family restaurant before heading back to chiang mai. bryan is back to nyc tonight as well and ending his 10 day journey in Thailand.

sunday update:

we got a little late start after going to bed way late the night before but headed off to jatujak market in unbearable heat so that bryan could get a sample of market life here. sadly, none of us bought anything but i did drink some cold crysanthemum tea. after exploring the market, we headed back towards siam and i took chris and bryan to jim thompson's house. jim thompson, an american former gi, is credited with revitalizing thailand's silk industry in his name still carries on at many of his silk stores throughout Bangkok (and abroad today). he was a former architect before he served in the armed forces during WWII and loved Thai art and culture. To build his house, he traveled throughout Thailand and bought all these ancient Thai teak houses on stilts and brought them back to Bangkok, where he re-assembled them according to their ancient forms and connected them together to build a larger Thai-style house. Now, his house displays his vast collection of Thai art, Chinese porcelain, and more. it's a great museum, really manageable, and there are tours in English. jim thompson disappeared at age 61 - an age a Thai astrologer/fortune teller told him that he must be careful of danger - on a trip to malaysia and no one knows what happened to him. the paper with his reading from this Thai astrologer still sits framed on his wall in the library.

because he believed in astrology, jim thompson also had a series of paintings/drawings depicting the siamese zodiac with one for each animal of the zodiac. we thought these were pretty cool and each picked up a print of our animal (bryan - horse, chris - sheep, tanya - monkey) that came with an explanation and horoscope breaking down the type of person you are from the month and day of your birth. i am a wild monkey, chris is Lord Buddha's sheep, and bryan is (sadly) a horse with a broken leg.

after jim thompson's house, we met up with nan and took a taxi to mon's restaurant, prachak, which has been in her family for four generations. it's a hole-in-the-wall but well known throughout bangkok for its chinese roast duck, bbq pork, and dim sum. my oldest uncle ate here when he was in medical school back in the day. we chowed down on tons of yummy food and then had some down time at uncle likhit's apt before heading to the airport. bryan's flight (bkk-nyc) left at 1 am, so he had a little extra time and started his blog of our trips here.

now we're back in chiang mai....and im back to work tuesday!!

mae hong son

although we only spent two full days in mae hong son, we definitely packed in the sightseeing. mae hong son is a province located in mountainous northwest thailand bordering burma and is most famous for its diversity of ethnic minorities, good weather, and blooming sunflowers covering mountains in nov-dec. the winding mountain roads are often treacherous due to the inordinate amount of curves you have to drive through (1,864 curves in less than 300 km from chiang mai-mae hong son...there are shirts sold in mae hong son saying 'i survived 1864 curves' as well as certificates you can get from the local tourism office). we took the easy way out because we flew on a prop plane (30 min flight vs 8+ hr drive) and it was well worth the extra $ we had to pay because i would definitely have gotten carsick.

first night in maehongson:

we wandered around the center of the city, featuring Jong Kham Lake, and two famous Shan-style temples (Shan people, also known as Tai Yai here, are from Shan State in Burma), Wat Jong Kham and Wat Jong Klang. there are parts of the temple that are forbidden for women to enter, which is common in Shan-style temples but made me kinda :( because that's uncommon in most of Thailand. these temples featured an interesting collection of carved wooden figures and also a small museum with random things (ie foreign currency). we also watched a show on the National Geographic channel about one man's attempt to catch civets in Indonesia (he failed).

dinner at fern restaurant, supposedly one of the best places for thai food in maehongson (according to let's go thailand, anyway). live music performed by guy on guitar who sang covers of farang songs. pretty decent green curry and bbq chicken wrapped in fern leaves.

first full day in maehongson: breakfast at the hotel (included in the price of the room), then off to sunflower cafe to meet our driver for the day. we had a roomy ford truck and bryan sat shotgun so chris and i had the backseat to ourselves. the driver couldn't speak hardly any english so took to conversing with me even though he really wanted to talk to the guys. highlights of this looong day trip included:


elephant riding (this was mostly for bryan , who claimed he didn't care if he rode an elephant or not, but chris and i knew he was lying). bryan got his own elephant and chris and i rode another named mapae, who was 28 years old and very happy and playful. the mahout was laid back and let mapae generally do whatever he wanted, which included stopping to eat a lot and tear leaves and branches out of trees/brush and play. the mahout also had a slingshot and collected pebbles to shoot at random noises or mapae if he wasnt paying too much attention. the ride itself was fun but the scenery was not as interesting as i had hoped. we did get to cross a river though, which was cool.

paduang karen village (also known as the Long Neck Karens) the situation of these people is sad because they fled burma to thailand but are still stateless. their village is set up mostly as a tourist attraction for people to come and see the women who have a cultural practice of putting metal rings around their neck to give the impression that their necks are elongated. women can start wearing neck rings at the age of five and gradually add more and more rings as time goes on. supposedly, the metal rings push down on the clavicle but don't actually increase the length of the neck. we didn't take pictures of the women because i felt it was kinda exploitative, but supposedly they all have a choice as to whether or not to wear the rings and can also remove them if they don't want to wear them anymore.

mae aw village - this is a former Kuo Min Tang Chinese village on the Burmese border. not much to see here, but we did get some home-cooked man tou (chinese buns), sampled some tea, and ate good chinese food (fried pork, chinese sausage, and vegetables with mushroom oyster sauce). there were lots of free roaming horses and cattle in this village as well.


tum pla (fish cave) - local Shan believe the fish here are sacred and don't kill them, so they grow up to 1 m in length. tehy are soro brook carp and are bluish colored, and found only in six provinces in thailand. the cave was interesting because you could see the fish trying to swim against the current into the rock but supposedly no one knows where the water comes from (you see the fish from a cavern, not really a cave). we fed the fish here lettuce, tangerines, and fish food. the tangerines seemed to be the biggest favorite. note how big the fish are (in the really clear stream) in this pic!


random coffeehouse in the 'switzerland of thailand' (pangtong palace?) - at this homestay, our driver showed us coffee plants (i never knew what they looked like before) and giant bamboo groves. we also saw the 'roasting room' where coffee beans were roasted.

phu klon mud spa - according to the guy who introduced us to the menu at the spa, there are only three mud spas like this in the world with the other two being located in romania and israel (random, right?) the hot springs at this mud spa warm the mud, which is taken and purified. next, some thai traditional herbs are added to the mud and it's left out to bake in the sun. at the spa, you can see a mud pit, get a mud mask, or do a full body mud wrap. chris and i did the full body mud wrap while bryan got a mask. it was fun and not really spa-like at all (we were painted with mud and had water dumped on us from a big trash can in wooden 'shower' stalls by the spa workers when it was over - very thai style) and i felt like that it really did make a big difference. the spa workers, like many others in thailand, were convinced chris was thai and decided that we should be having children.


Wat Phra That Doi Kong Mu - this temple is on a hill overlooking Mae Hong Son town with an amazing view of the city and the surrounding environs. Two Shan stupas house the ashes of two famous monks from Shan State in Burma. Like many other wats that we toured in Mae Hong Son, one of the chedis at the temple had different Buddha images for each day of the week. You can make merit by donating to the Buddha corresponding to the day of your birth. The Buddha image for Sunday, for example, is standing, while Bryan's Buddha image (Saturday) is sitting on the coils of a naga (mythical serpent). The naga has many heads and uses them to make a roof over the Buddha to protect him from the falling rain.

Another interesting contraption related to the Buddhas corresponding to the day of your birth is a Lazy Susan-like thing holding different bowls with the days of the week labeled on them. These are encased with a glass box-covering and a slit for coins or bills is made at the top of the glass box. When you step up onto this wooden box, a motor activates that turns the lazy susan. You get off the box when the bowl corresponding to the day of your birth comes under the slit for putting money in and then drop coins or bills into the bowl, hoping they fall in. i had bad luck the first two times i tried this and didn't succeed, but the third time i was successful. making merit can be fun after all ;).

on the way back down the mountain from this wat, we noticed other wats and staircases leading to the top of the mountain, so we decided to walk there after we got dropped off at the hotel to check them out. i don't remember the name of the first wat we went to, but there were a series of faceless buddhas sitting in a circle in the museum there that i found intriguing. also, there was a large seated Shan-style Buddha outside as well as stone lions guarding a tall (old-looking) stone naga staircase. needless to say, we didn't make the trek up the stairs but had fun exploring the area around sunset.



dinner at kai mook, a local chinese-thai restaurant, where we tried local curry with wild boar. wild boar didn't really taste like anything, kinda like bland super chewy pork. we also had bananas fried in batter. after dinner, we walked around the local night market again & picked up a few souvenirs. chris also bought his absolute favorite food ever, moo ping, or marinated pork on a stick, and was instantly a star among the local temple dogs there, who followed him around and begged for pork until he gave them a little to eat.

second day in maehongson: the driver of our truck offered to take us around again and came up with an itinerary that seemed okay, so we hired him for another day. the big highlight of this trip was a huge cave, called Tum Lod. Tum Lod is one of the oldest known caves in Southeast Asia and is made of limestone. There is also a wide stream running through it with huge blue-green fish. At sunset, or around 6 pm, tons of bats and birds fly into the cavern to sleep. If they run into each other or one falls into the stream, they get eaten by the fish! we didn't get to see this, but our guide confirmed that it was true.

The cave is made up of one main cavern with three caverns coming off of it. We had to hire a guide with a lantern and a man on a bamboo raft to take us to the different caverns, which we explored by climbing up lots of wooden stairs. In one of the caves, also known as 'Coffin Cave', there were many wooden coffins that were discovered by anthropologists years ago. In different areas of the cave, there were children, women, and men buried. Another cave, nicknamed 'Doll Cave' at all these rock formations that looked like small dolls. Overall, the experience was pretty amazing.

Wat Tham Wua Sunyata - a forest monastery located on a large parcel of land. This wat was very peaceful and beautiful and focuses on running vipasanna meditation retreats. We explored the meditation cave, which was more like an outpost from a short limestone cliff, and the main hall with large Buddha images.

lahu new year celebration - we just happened to run across the end of this village's new year's celebration on our way back from mae aw village and our driver stopped to see what was going on. basically, drunk guys were lighting unbearably loud firecrackers while a few men in the middle of a circle were playing traditional music while a larger circle of women danced around them. free cold drinks (red and orange pop, water, and beer) were distributed to anyone at the celebration, and everyone was decked out in traditional costume. people were friendly to us and i was happy that we got to see a local cultural celebration.

Sesame oil ground by water buffaloes/cows - located in a little house with an open hut in the backyard, this is the only place in the North that still makes sesame oil 'the old way'. The method is simple - basically the cow/buffalo is hooked up to this wooden contraption and walks in a circle. As the cow/buffalow walks, the wooden pestle grinds the sesame and the oil is collected from the bottom. One bucket of oil takes about three hours of grinding. Once the oil is done, it is purified and then used to make different products such as lip balm (which i bought!).

the flight back to chiang mai was pretty non-turbulent and i decided that maybe prop planes weren't so bad. for dinner, we dropped in at pasta cafe & also had some homemade ice cream (i tried red bean & green tea - yummy!) on the walk home. the next day, we were off to bangkok!

a little buddhism with bryan & the giardia story

bryan, one of my best friends from college and a groomsman in our wedding last august, left N. America for the first time to come visit chris and i in thailand. he arrived last friday and we did some standard chiang mai tourist stuff (seeing lots of wats, walking around the old city, shopping at Warorot Market, and hanging out by the Ping River) for a few days. Mostly it was just me and bryan hanging out because chris was recovering from Giardia (more on this below).

one of my fave parts of the wat circuit again was being able to have a short chat with a monk at Wat Prathat Doi Suthep. bryan had read some of this book i picked up there last time (karma for today's traveler) and we'd had some discussions about buddhism before we went to the temple. one question bryan had was why (according to buddhism) you would have to suffer the consequences of some bad thing you did in a past life when it wasn't really you that had done it, and i think the monk did a good job of answering the question by talking about his concept of 'self' and the buddhist concept of rebirth. he also gave a great analogy for karma, comparing it to salt water. in this analogy, salt represents bad karma and water represents good karma. some people have really salty water to begin with but can add water (by doing good deeds) to make it less salty. alternatively, you can also make pretty clean water more salty by adding salt (bad deeds). because your sins can't really be forgiven in buddhism (or 'cleaned' away), all you can do is "shift the balance of the compartments" by adding either salt or water (and it's your choice). it may take a long time to see a difference though - like the monk said, you can't expect to shift your balance overnight if you've been doing bad things (or have really salty water) with just a few drops of good.


Giardia story:

I always make fun of Chris for his stomach being "weaksauce" in Asia. Thus it came as no surprise that Chris got his first parasite in Thailand (he figured it was from some of the stream water at Jae Sorn Park where we went camping a few weeks ago). i took him to the hospital sunday to get some blood drawn because he had been having diarrhea all night and had just finished a 5-day course of Cipro that i had bought him with not much improvement. we didn't have to wait very long and first met with a cardiologist (staffing the internal med outpatient clinic in the AM) who took his history, did an abdominal exam, and ordered labs. she was later called to the cath lab so we went over the lab results with a GI doc who was called in to take over clinic. i was able to look at chris's labs before we saw the doc again and it was much as i expected - he was dehydrated (Hb 17) and his white count wasn't elevated, but there was a left shift. His stool sample was also positive for occult blood. the GI doc was pumped that i was a medical student and could speak thai, and said that he was going to prescribe an antibiotic for chris. i was like, hello, he already took cipro for 5 days and it hasn't gotten better. he suggested taking a 7-day course of cipro (for traveler's diarrhea) and then i was like, well, i was just going to start giving him flagyl. he agreed with my plan and said that if chris didn't get better in a few weeks he should come back so they could send his stool for O&P. i was like, who wants to have (bad) diarrhea for weeks? we ended up just buying flagyl and now chris is better. i thought to myself, hey, i might not be such a bad doc after all. :)

although chris is better now, he originally flipped out on me after he read this forum about all the nasty side effects people had after taking flagyl. he woke me up after taking one dose to discuss his concerns. i was like, 1) is it good to trust everything on the internet? and 2) is my husband one of those problem patients? after talking to him about it (and a few days of him realizing he didn't have any side effects), he decided that he would rather take flagyl than having diarrhea for another month.

Mae Hong Son:

With Chris mostly recovered from his bout of Giardia, we decided to fly out to Mae Hong Son for a few days since we'd never been there before and Bryan wanted to see the mountains. After checking out one nasty guesthouse, we gave in to our snobbiness and got two rooms at a hotel in town (clean sheets, air conditioning, private bath with hot water, breakfast = 800 baht a night, or around $20). I also booked a private car with a driver from a local cafe to take us around for the next day. The car ended up being a comfortable Ford truck and the driver/guide took us around to a lot of the local sites, which included temples, a fish cave, hilltribe and minority villages, and more. I'll post pics and info tomorrow!

yay!

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To find out what specialty best fits your unique personality, go to:

What Medical Specialty Is For You?

fun with friends in february

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

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

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

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

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

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

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

Farang food:

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

work:

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

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

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

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

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

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

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

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

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

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

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

We'll see what happens in the end though!

temples and treks (in the old city)

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

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

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

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

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

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

gig_vitara says: hello. is ok.

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

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

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

gig_vitara says: Oh.ok

tanyaporn.wansom says: did you go to pai

tanyaporn.wansom says: last weekend?

gig_vitara says: yes 6 person.

tanyaporn.wansom says: oh :(

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

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

tanyaporn.wansom says: that sounds fun

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

gig_vitara says: by car gig,

tanyaporn.wansom says: we can go however

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

gig_vitara says: we can comeback again.

gig_vitara says: :)

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

tanyaporn.wansom says: what you do later tonight

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

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

gig_vitara says: no plan.

gig_vitara says: ok.. we can travel.

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

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

reading list

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

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

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

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

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

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

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

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

visitor-o-rama

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

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

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

Flower Show with Nan, Mon and Ben

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

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

Chris and I paying our respects to the Buddha

Wat Phra Singh with Nan

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

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

Liz's midnight snack

reproductive health clinic

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

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

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

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

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

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

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

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

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

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


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

there's still so much work left to do.

bombs in bangkok

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

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


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

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