the end of an era

granted, the title may be a bit dramatic, but my time in chiang mai is quickly coming to an end. the days here seem even more numbered since chris left tonight and im writing this after returning to what feels like a really empty apartment. chris and i have lived in this studio (together) for the past six months and since he's Star Alliance Gold, he was able to check in three bags from chiang mai home. this was nice because he ended up taking most of our stuff, and i just have to bring one bag (mostly with my clothes and maybe some books) down to bangkok when i leave chiang mai in a week (!).

chris is excited to go home, but i have more bittersweet emotions. thailand really feels like a second home to me, and despite the (many) frustrations i've had this year with the fogarty, i've always loved living and being in thailand. i feel really blessed and lucky that chris and i got to spend a large part of our first year of marriage together in chiang mai, traveling around thailand and southeast asia, and just enjoying being husband and wife without the stresses of school, work, etc. like most other times i've been to thailand, i've made some really great friends here and expanded my thai 'family'.

there's lots to love about thailand. food is number one on many (including me and chris's) lists. food is seriously available here 24-7 and can range in cost from snacks for 5-10 baht to straight up meals (rice/noodles) from 20-40 baht (a little more than a dollar). street food culture is strong here, but there are also stalls that have seating areas, especially at night food markets, and a broad range of restaurants. chris's favorite thai snack , moo ping, (marinated pork on a stick), sells for 3 baht a stick, and is eaten with sticky rice. once, when i was gone to a conference in bangkok, chris ate it for dinner and was really proud that he spent less than $1 on 10 sticks of moo ping and sticky rice.



in chiang mai, chris and i eat thai, chinese, laotian, mexican, american, and italian food on a regular basis. there is such a diversity of things to eat and we've become friends with some people at local restaurants and food stands, including the couple who sells fruit on our soi. they know that chris and i always get green mango (for me) and pineapple (for chris), but will explore other options (like cantaloupe, rose apple, or watermelon) if our faves are sold out. you get a bag of cold, sliced fruit for 10 baht and it's seriously a terrific (and filling) snack on a hot day. this reminds me - i have some green mango in the fridge now! :)

fruit and veggies are really cheap here and there's many kinds of both that are hard to find (if available at all) in the states. besides raw fruit, you can get smoothies/shakes/yogurt mixed with fruit all over the place. i dont really even know what most of the fruit/veggies are called in english, but ill try to figure it out and update you all.

ok, maybe i should start sticking to a list format before i start waxing poetic about every other thing ill miss about thailand ;) following is a list of things i love about thailand:



1) The people, esp. my friends and family. I like that Thai people are generally friendly, laid-back, and that friends are really like family here. For example, one of my friends who lives in Bangkok offered to come up to Chiang Mai (a 9 hr bus ride each way) to help me clean my apt and pack to go home. I told her that was too much, but I think she's coming anyway.





I think it's nice that certain traditions are also preserved in Thailand, like celebrating Thai New Year by wearing traditional Thai clothes and conducting a ceremony where you pay respect to your elders (we just had this ceremony at RIHES last Friday). It consisted of everyone participating in a small 'parade' from the second floor to the fourth floor of our building. The procession consisted first of Thai musicians, followed by men carrying special water in silver bowls used in the blessing ceremony (elders bless younger people by splashing water over your hands), and women carrying gift baskets. Later, we all gathered in this assembly room and sat on the floor while some RIHES women performed a traditional Thai dance with knives and then listened to each 'elder' present at the head table give advice and blessings for the coming year. At the end, we formed a single file line and got blessed by all the elders. I like that stuff like this happens every year because I feel like it builds community and makes you feel like you're part of something bigger than just yourself....I also always love hearing elderly people tell stories about back-in-the-day and imparting their experience and thoughts on us young peoples.


Another nice Thai thing is having EVERYONE and their mom go to the airport with you to send you off if you're going on a big journey (returning to the US for a long time counts as one of these events). I think that this might be happening less since the airport was moved to Suvaranabhumi and it's expensive (and difficult) to get out there right now, but I'm sure I'll still have a few friends with me at the airport at 4 AM to help me check in for my flight at 6 AM. Heck, how hard is it to find someone in the US to take you to the airport at that time? (Y'all know what I'm talking about).



2) Last minute plans (or lack of plans at all). Thai people sometimes dont really plan things in advance, but just call you and are like, "Have you eaten yet?" "Do you want to go camping?" "Are you available right now?" This has both good and bad sides, but most of the time it's fun and we've been on lots of adventures that we never planned on...and we've done our share of last minute bookings at well (see previous phuket entry - we booked that ticket the day before we left!) I also appreciate that temples are open spaces and that you can drop in at any time. Chris and I visited two local Burmese temples before he got on the plane to make some donations and also ask for a safe trip home. I always feel welcome at temples and friends who have visited (of other faiths) have also noted the same feeling when visiting temples in Thailand.

3) Thai karaoke (plus cheesy dances that go along with the karaoke). Chris loves it too, even though he doesn't really understand what's going on (I explain it to him). We also sing our tried-and-true boy band songs at karaoke when they're available.

4) Quality of life. My quality of life here could seriously NOT be better. although we wish we had a washing machine, we send our laundry to get done (washed, dried, folded/ironed, and delivered to our door weekly) and it generally costs less than $3 a week for both of us. we also used to have a maid come to our apt once/twice a week (included as part of a rent) for around $8 a month. Besides help with housework, I also enjoy regular massages ($3-$5/hr) , pedicures ($5 for a super nice one), and get my hair washed and blow-dried ($2). obviously, NONE of this stuff happens for me in the US, unless im treating myself to something special.

5) DIY/handmade stuff. I really appreciate all the little shops/boutiques/stalls, street culture, and the ability to get unique clothes, accessories, and home stuff for really cheap (or pretty reasonable) prices at such places like the market in front of our local mall (Kad Suan Kaew, held Thurs-Sat nights during the summer), 'Walking Street' on Sundays (where a few miles of the 'old city' gets shut down and filled with vendors selling everything you could imagine), JJ market or Suan Lum Night Bazaar in Bangkok (sadly being shut down later this month), or in the night markets held around Chiang Mai University.

6) Since Chris doesn't understand Thai TV, we've been semi-addicted to this channel called 'Zone Reality' which doesnt have any commercials (I'm not sure how they make $..all their commercials just advertise different shows that they play). They apparently buy seasons of shows and then play them over and over again. So far, we've seen tons of Rescue 911 episodes, most of the episodes from Seasons 1-3 of Hogan Knows Best, quite a few episodes of Dog: The Bounty Hunter, and then an assortment of different forensic/crime shows (ie Dr G: Medical Examiner). Sometimes we also watch National Geographic Channel in Thai.

7) Our motorcycle. I've really liked riding around with Chris through the city this year - you definitely avoid getting caught in traffic jams and it's easy, cheap, and fast. We're both looking forward to driving when we get home though (I can't believe I haven't been behind the wheel in over eight months!)

OK, that's about it for now. More posts to come!

phuket!

at the last minute, chris and i decided to fly to phuket to visit my uncle gin before heading back to the US. we hadn't seen him since we've been in Thailand and we'd also not been to the beach, so we thought it'd be a perfect opportunity to do both. we stayed with my uncle (on the second floor of the tour agency where he's a manager) and got to spend some quality time with him, mostly while eating, and some of his friends.

the first night we got to phuket, our uncle took us to his co-worker (and friend's) house noom. noom's current partner is a swedish guy who owns this crazy three-story house on a small hill overlooking patong beach, one of the major beaches in Phuket. this house features two pools (one on the second and third floor), a fantastic view with balconies/decks all around, and more. noom & his partner were hosting a barbecue and we gorged ourselves with fish, shrimp, pork ribs, and bell pepper skewers. in the remainder of our three-day trip, we ate TONS of other yummylicious food, including lots of chinese-thai style food, including pork & mushroom hot pot, shrimp wonton & noodle soup, fish noodle soup, and pa tong ko (or you tiao in Chinese, a yummy pastry). we also had some great seafood, which phuket is renowned for. our uncle took us to a local place with his friend pui, and we all feasted on fish from the Andaman Sea, mussels made with this yummy ginger and basil sauce, crab, and giant prawns.

our second day in phuket was spent on an all-day boat tour of Koh Phi Phi and the surrounding environs. the highlight of this trip was the amazing snorkeling we got to do at Khai Nok Island where there's a HUGE coral reef with tons of fish. this was chris's first time snorkeling and he had a good time (despite still recovering from his sprained ankle). we also got to enjoy some beach time on the white sand beaches of the different islands, feed some monkeys from our boat at 'Monkey Beach', and peek into a cave renowned for swallows' nests (which they use to make bird's nest soup, super expensive and famous among Chinese people). you used to be able to go into the cave to take a tour and climb a bamboo ladder, but the cave was bought out by a private owner a few years ago and now it's closed to the public. it was kinda weird to be a tourist-for-a-day, but we got to sit next to the only other thai family on the boat and they chatted with me for a bit before our trip ended for the day. (commonly asked questions, which they asked once again: are you thai? what about chris? what do you do here? can hiv/aids be treated? when you 'grow up'/finish school, are you going to practice medicine in the us or thailand? etc.) overall, we had a good time even though the waves were pretty choppy and it wasn't super sunny, and we were happy to return home to our uncle's place at the end of the day.

our third day in phuket was pretty uneventful since my uncle came down with a bad chest cold and spent half of it sleeping. we hung out at the office for half the day, watched some movies (the pursuit of happyness, little miss sunshine) and watched the tour agency staff play some cards. in the afternoon, we ran some errands and stopped at a local jewelry store (Gems Gallery), which claims to be the biggest jewelry store in the world (i don't know if this is true, but it is pretty big). my uncle's good friend pui, who used to work for the store for twelve years and helped set up the chain in Phuket, helped me pick out some pearl jewelry and then hooked us up with a major discount. chris joked that i could finally put the commonly heard 'you didnt get me a wedding present' to rest. all in all, im very happy with the purchases, which include earrings, a necklace with a single pearl, and a pearl ring. yay!

now we're back in chiang mai after a long trip from phuket. there's no direct flight from phuket to chiang mai, so we had to take a flight from phuket to bangkok and then connect from bangkok to chiang mai. the chiang mai flight was delayed (something about a plane being disabled and blocking the runways) for about half an hour. in any case, door-to-door it took about six hours to get home. we're pretty knackered now and are just chilling out for the rest of the night, but things need to kick into high gear tomorrow. i can't believe my year off is almost over...more reflection on this point in a future post.

happy songkran, or sawadee pii mai!

thai new year (celebrated this year from april 13-17) is madness in chiang mai. traditionally known as a water-pouring festival, songkran has turned into more of a water-throwing "fight" of sorts. not a mean-spirited fight of course, but pretty intense nonetheless. we don't have tons of pics of actual songkran celebrations, mostly because chris already lost one camera to water this thailand trip and we didn't want to risk losing another.

the actual new year was celebrated on april 13th. at 8 am, dance mixes of popular (American R&B/hip-hop) songs started blaring from loudspeakers conveniently positioned across the street from our apt into our windows. it was like having a dance party in my room all day (from 8 am-7 pm). people began flooding the streets around 10ish. there are two groups of people who go out to celebrate songkran, people who walk and people who sit in the bed of a pickup truck. there are also other groups (like people who stand on the sidewalk/edge of the road with hoses and buckets waiting for you to drive by). chris and i have been both at different points of our songkran experience. i will share with you the finer points of either here:

1) People who walk. If you're going to an area where there is hardcore Songkran celebrations going on, you'll likely get wet, especially if you walk along the side of the road where trucks are going by (usually at like 1 mph). Getting wet while walking is not so bad because people generally (unless you are in the moat area) don't dump TONS of water on you. People who walk usually carry water guns (ie small amounts of water) and are not dangerous to you (unless totally wasted, which is not uncommon.)

2) People in pickup trucks. It is fun to sit in the back of a pickup truck if you have adequate water-throwing materials (a huge 32+ gallon trash can filled with water, buckets, etc). We had kinda wussy water-throwing paraphernalia (really small bowls, a small basin used for laundry to hold water) when we went out to Mae Tang yesterday, but it was fun anyway. What happens when you are in a pick-up truck is you get water thrown on you by other passing pick-up trucks and also by little kids (and adults) who line the sides of the road/freeway/whatever, and dump water on you (some of it ice water). We are not talking about small amounts of water here, people. Gig, Aum, Chris, and I got drenched at least 20 times (but mostly Chris and Gig). Sometimes the water is not the cleanest (as people collect it from wherever they can, including ditches, etc.) and Chris is currently on a course of cipro s/p getting some river water in his mouth.

Other times you may be targeted by water-pourers/throwers is when you are riding around on your motorcycle. You cannot avoid this, even if you do not ride in the lane closest to the sidewalk. Chris and I thought we were being smart by riding in the other lane, but learned our lesson when we got totally dumped on by a passing pick-up truck. Lesson for Songkran: Accept that you're going to get wet, be good-natured about it, and bring a change of clothes if you're going anywhere where you care about being dry.

one of the oldest temples in Chiang Mai. During Thai New Year (this also happens in Laos), one ritual that many people participate in is the washing of Buddha images. Gig washes (ie pours holy water) on the Buddha in front of Wat Phra Singh every year and invited us to go along (so we did, on Friday afternoon-eveningish). in the north, there's also a tradition where you build 'sand' pagodas. in the old days, people would bring a bucket of sand to the temple to and dump it on the temple grounds. This would help keep the temple dry when the rainy season (next month) came. Nowadays you can just 'buy' a bucket of sand for a donation at the temple and pour it (and place a banner/flag of sorts in it) in a designated area. for some reason, we got sidetracked after pouring the water over the Buddha and didn't pour sand. we did, however, put tons of satang (coins) in alms bowls placed in front of the eight Buddhas (for the days of the week - see mae hong son posts for more explanation.)

other chiang mai songkran highlights included a long-awaited barbecue at maddie and north's place (great homemade potato salad by maddie, pork, shrimp, thai seafood sauce (also homemade by maddie), beef kebabs, and a little too much beer for tanya) & pancakes (and my fave, durian) at joanne and ben's place. we've also had more than our fill of ice cream at the (somewhat) newly opened Bud's Ice Cream of San Francisco in Nimman Promenade. next post - phuket! (where we are now)

play!

besides work, there has been lots of playtime as well! im currently writing this entry from my uncle's apartment in Bangkok, where we're spending some time with Chris's parents who are in town for a few days. (more on bangkok later)

in the past week, chris and i have been pseudo-party animals. this for us means meeting up with people almost everyday (and night). we usually have a much more laidback existence, but for some reason, we kept getting invited out. here are some highlights:

last weekend, we spent a lot of time with my fellow co-worker lara, her husband (and really great artist) rung (pronounced roong) , and her son (aged 7), raksin. it was awesome to be in a 'family' setting again (ie with a house, kids running around, etc.) and chris noted the different kind of energy he felt while we were visiting. it reminded me of being in college and getting invited over to your prof's house and being like, 'wow, a real house (with real food)', interacting with people of different ages than you outside of a work/school setting, reminding yourself that there's a world outside your own. i know that there are lots of different kinds of families (im not trying to be heterosexist or kid-centered here) but in thailand, we mostly hang out with people around our age/in our studio and it's a treat to be invited over to a house or on a road trip (in a car) since we just have a motorcycle here.

in any case, we spent a bunch of time at lara and rung's place over the weekend. chris was jealous that rung had his own little house/studio next to their main house and we got to see some of his works-in-progress (he is doing a major exhibition on the Thai King next month in Bangkok). as a typical first-grader, raksin was running around everywhere, and had his toys/books spread out in the garden area. saturday morning, lara made us yummy banana pancakes and coffee for breakfast and we chatted until lunch, when we headed over to a neighborhood laotian restaurant. the owner is apparently a famous pop singer in luang prabang (where chris and i just returned from) and we had some really great lao-style pho noodles, laab isaan (minced pork/spicy salad), and sweet peanut dip. rung also introduced chris to a new moo ping (marinated-pork-on-a-stick) stand in their neighborhood.

on sunday, lara called up in the afternoon and asked if we were interested in going to Mae Sa with them (about 45 mins away, in the mountains). she warned us that it would be a kidfest with her friend caroline and her two kids coming along. we didn't mind, so joined them for a road trip up to their friend's resort (Proud Phu Fa). on the way to the resort, we stopped at a small waterfall for the kids to play in and had some snacks. the resort was really beautiful and designed by the owner himself ( he was a classmate of rung's when they studied art together at CMU). we hung out by the pool, watched the kids run around in the large garden, ate some delicious vegetarian thai food, and enjoyed the full moon over the mountains. chris and i were most entertained by the fact that lila, caroline's daughter who just turned 4, switched back in forth between perfect thai and british english. language acquisition among children is really intriguing and amazing to me. it's also interesting to hear about how kids navigate between different languages (and different worlds). raksin is sometimes confused when people don't match his expectations of what language they should speak - for example, when we were out a local restaurant/pub named sudsanan the other night, his dad was speaking thai to a swedish dude joe. raksin asked his dad, "is joe thai or farang (foreigner)?" and his dad tried to explain that joe was a foreigner, but that he spoke thai. raksin was also originally confused by me (and chris) but after a few days decided we were cool and just spoke whatever language he wanted to us.

more family stuff: since chi (our next door neighbor) and family are going on vacation to the tibet/china border for a few weeks, we were worried that we wouldn't be able to hang out with them before chris headed back to the states. things were pretty hectic with their schedule, but wednesday night they ended up being free so we hung out at their place and ate these yummilicious hamburgers that chi made. i also split a bottle of singha beer with chi (chris refused to drink) and hung out/chatted with chi while chris played legos with jasmine (their daughter, also seven). later, we watched disney's high school musical with jasmine and ate homemade chocolate chip cookies before heading off to bed.

non-family stuff. one of the ma staff who moved to bangkok to be with her bf returned to CM for a few days because her bf was having his commencement ceremonies. (note: a member of the royal family has to be the one handing you your diploma at graduation, so commencement ceremonies are held year-round in Thailand). we went out drinking with some of the ma staff at the same bar we had pae's birthday celebrations at months ago (i think october, before chris came). the dudes were really funny (esp this one guy, yai,) because they were really drunk and wanted to talk to chris (in english). basically what this amounted to was ying sitting next to thai dude (yai or noom), who asked her how to say stuff in english, then the thai dudes trying to speak in thai (or english) to chris, then me half-listening and trying to translate and then chris responding. after awhile, they cut out the middlemen and started speaking thai-glish among themselves. i was actually very impressed with chris's thai.

two bottles of whisky later, people were pretty drunk. a carnival/fair was set up nearby and chris, kae, and ying tried their hand at darts (you must break seven balloons with your darts to win a prize - otherwise you get really crappy consolation prizes). chris and ying both popped six balloons, and kae popped five. disappointed with the results, we ended up going to eat rice porridge (kao tom) at a streetside stall before heading home for the night (this was tuesday, mind you!).

celebrating chris's birthday:

chris turned 28 on thursday, which was also the day libby came into town. i went to clinic in the morning (and saw a cool case of herpes zoster) but chris picked me up for lunch. we went to the big mall here, central airport plaza (yay air conditioning!), ate at fuji (one of our fave japanese restaurants), took sticker pictures, and played basketball. at night, we met up with ben and libby, hung out at ben's house for a little bit, and then went to House, a fancy CM restaurant, for dinner. my fave part of the meal was chocolate almond cake (chris's too)!

the next day, we had a lazy friday brunch at bake 'n bite with libby and ben which was super nice, stopped in at wawee coffee, and then headed to kad suan kaew to meet up with ying and kae. there, we stuffed ourselves with pizza, and went shopping for a bit. when we got home, we packed a bunch of stuff for our overnight bus trip to bangkok. ben and libby stopped by briefly again, and then p'nui (poo's fiancee) picked us up to take us to the bus station. nine hours later, we arrived in bangkok. more updates on bangkok later!

ps echoing a sentiment from james hudspeth's blog: im also looking forward to going home..just not looking forward to leaving. we heart chiang mai :)

work (and play)

post-luang prabang, everything kicked into high gear. let's talk about work first, since i always put off talking about it in my blog...there's so much other fun to be had.

moving forward:

1) Quality of Life paper (evaluating the validity and reliability of two QOL questionnaires, the MOS-HIV and SF-12 in Thailand)

Dr. S returned from the US and met with me to talk about some of the new stats that Dr. A wanted in the paper. He also talked to me about the order of authorship and i was a little let down because he told me i would be second-to-last even though i essentially wrote the entire paper. After consulting with some friends, i have decided that when i send the final draft out (hopefully this weekend) i will ask him if it's possible to be second author.

Although i know authorship is pretty political, i think it's nice to be able to support students. i was really hoping to have a publication in a peer-reviewed journal before residency apps, and one of the other people on the paper is also keen on having me achieve that goal. i hope i remember what it's like to be a student when im an attending writing papers somewhere and give authorship to up-and-coming peoples over those who already have a ton of papers anyway.

Anyway, besides the authorship thing, the paper is pretty close to (my) final draft, so once it gets approved by the two main people on the paper, it will be off!

1a. Quality of life trial

The other trial that Dr. S is working on right now that i discussed in an earlier post (700+ pts started on ARV about three years ago, tons of data on EVERYTHING - quality of life, adherence, risk behavior, SES, etc.) is coming up on three years, where they're going to administer a battery of questionnaires again. The issue of lipodystrophy/lipoatrophy came up at a previous dissemination meeting with all the hospitals and Dr. A gave us some tools to look at from NIAID. Dr. P translated them into Thai and we pilot tested them last week in the HIV OPD clinic, which was fun (and interesting). Kinda reminded me of HIV-NAT days, when i helped Dr. Mark administer LD questionnaires.

After i finish the QOL paper on the validity and reliability of the two QOL questionnaires, Dr. S invited me to work on another paper (discussing improving SES, or socio-economic status, with starting HAART) with him. i also might help do some writing for the big (main results) paper that Dr. A is working on.

2) Reproductive health questionnaire

i finally got to have a meeting with the head doc and some of the nurses about incorporating a better intake/questionnaire form when women come to electively terminate pregnancies. they helped make corrections/clarify stuff on the form i wrote and agreed to administer the questionnaire and keep it separate from the identifier information. hopefully this is implemented soon (waiting for bureaucratic approval) and data can be collected! im kinda proud for pushing this point because i think it will really help with health services at the clinic and won't just be for me (and my research). i will finalize my CHR (Committee for Human Research) forms and hopefully qualify for a JHU exemption. ill likely have to return to CM sometime in the fall to collect (paper) data as well.

3) Thailand, TRIPS, and Compulsory Licensing : a lunchtime lecture by yours truly!

the clinical trial coordinators for each clinical trial meet once a month here to talk about clinical trial issues, collaborate, and sometimes learn about research/ethics/etc. the lunch is hosted by the regulatory affairs unit where my good friend lara works. with all the crazy stuff surrounding the compulsory licenses in Thailand, she was getting approached by lots of staff asking for more info about it. since she didnt know tons of background about TRIPS, etc, she invited me to be a guest lecturer at their monthly meeting yesterday.

i threw together some slides that i had from previous presentations and then combed through emails, read through the Thai MOPH (Ministry of Public Health) white paper that they wrote on the topic of their three recent compulsory licenses, and utilized the CP-TECH/KEI information available to me (yay Thiru!). lara gave me a super nice introduction and mentioned the time i had spent at the WHO. im actually really happy i participated in the Global Health Fellows Program now (even though it was a little crazy at the time, and i didn't finish my paper....maybe it will actually get done if my APHA abstract is accepted, esp. since SO much has happened in thailand since that time). i also made great friends in geneve - y'all know who you are.

before i went to give my presentation, liz noted (over AIM) that she thought i was never nervous. i think i get a little nervous before some kind of public speaking appearance (does anyone remember the first time they presented in the VA ICU - i do, and it was my first medicine patient of M3 year), but feel pretty comfortable speaking in front of a crowd, probably because ive done it a bunch of times. liz said i never seemed nervous even if i was. i hope this continues when i get back on the wards. :) back to the talk:

i was a little nervous that some of the staff (all Thai except Lara) wouldn't understand since i was presenting in English but tried to speak slowly throughout and staff seemed really into it. a few people were super engaged and asked me a lot of questions once it was over (and i think the people in the back were interested as well, but were trying to translate among themselves). lara said it was a big hit because no one got up and left even after she was like, 'ok, thanks for coming, it's over' and hung around to talk about it.

4) More quality of life (and other stuff) at Chiang Mai University

hopefully ill set up a meeting with one the head ARV clinic nurse today, who wrote this crazy long report in Thai about some research she did among ARV naive pts who started to take HAART on the NAPHA (the national HIV/AIDS treatment program here which offers universal access to those meeting treatment criteria). poo (ID fellow) gave me the report a few weeks ago and noted that Dr. Kuanchai thought something might be able to published from it. ive read through a lot of the report (all in Thai) and approached the author last week at clinic. i only got to talk to her briefly about whether she ever thought about writing anything in English/publishing in either Thai or international journals, and she said no. (she does all this research, writes it up and binds it, and then just puts it in the medical/nursing library. CRAZY!!) i think there's actually a lot of interesting data in her report and am going to see if she's interested in working together to put an abstract or paper together - hopefully this will get her involved and interested in disseminating her work/experience to others both here and abroad.


ok, play update later. gotta get ready for clinic!

PS Happy Happy Birthday to my husband, Chris!!
PPS Welcome to Thailand, Libby Houle!

luang prabang part deux

it seems like forever ago since we went to luang prabang even though we've been back in chiang mai for less than a week. i am motivating myself into finishing a luang prabang entry now by eating some really yummy cantaloupe, which is now in season.

the last two days in luang prabang focused on day trips around the city. on monday (3/25), we slept in, moved from the villa santi to the apsara boutique hotel (also a converted french villa), and then hung out in town at l'etranger bookstore for a bit before going down to the mekong river and hiring a boat to Tum Ting Caves, two caves carved into limestone cliffs that house 4500+ Buddha images (some of them are carved into the cave themselves). People visit the holy site every year in April around Thai/Lao New Year and bring Buddha images to leave in the caves or wash in holy water (there used to be a spring in one of the caves and a trough is carved into the wall for washing Buddhas). The tradition continues even though (i think) the water has dried up and i'm not sure if people can still leave Buddhas in the actual caves themselves. it was a really beautiful, relaxing ride down and we saw many aspects of river life -water buffalo bathing themselves in the water, men fishing and boating, women doing laundry, women and girls collecting river vines (similar to seaweed, which is then dried with sesame and tomatoes for a really yummy snack - see pic of chris with this snack drying in the sun), kids swimming, etc. we also stopped at two villages (one of them pretty touristy) and saw families making local rice wine, women weaving cloth, and people chilling at the temples. for those who have been to asia before (or certain chinese restaurants), you most likely have seen wine with crazy animals bottled inside, many of which are said to have medicinal properties. in this pic, i am holding a small vial of rice wine with a cobra inside.



after enjoying sunset on the boat, we walked to l'elephant, the most famous french restaurant in town, for dinner. chris had buffalo steak (which he said was ok) and i had this amazing pork dish with basil mashed potatoes and super yummy blue cheese & walnut salad. for dessert, we had a fruit tart with french pastry & chocolate mousse. perfect way to end a long day :)



on our last full day in laos (monday, 3/26), we woke up early (around 6 am) to participate in giving alms to the monks and novices who make their morning alms rounds in the city. this is a Buddhist tradition where monks and novices take their alms bowls and walk barefoot in neighborhoods in order to give lay people a chance to offer food and drink for the day. monks generally eat only once or twice a day and are not allowed to eat anything after noon (or midday). luang prabang is one of the few cities where this ritual is still a part of daily life and thousands of monks and novices (and many lay people) taking part in it. chris and i went out at 630 and were a little late already, but we were able to buy two baskets of sticky rice and had some fruit from the hotel that we gave to the monks. after alms was over, chris and i enjoyed breakfast ourselves and then took a hired car to Kuang Si Waterfall, a national park and animal reserve. we had heard before that there were bears and a tiger at the waterfall and were kinda dreading seeing animals kept in crappy conditions, but were pleasantly surprised when we found a large enclosure with many Asian black bears playing and sunning themselves.

there were also kickass signs in english about the bears and tiger (housed separately), the situation re: hunters/poachers (most animals were saved and repatriated by the lao gov't who caught them after they had killed their parents), and what we could do to help. on our way back from the waterfall, chris and i ran into one of the australian volunteers who was working with the bears. he gave us a lot more info about the bears, the rescue mission, and advice on what size shirts to buy. one cool fact about the asian black bears is that they have this v-shaped stripe on their necks that's like their own fingerprint (every one is different). also, because it's kinda in a crescent shape, lao people decided to call them 'moon bears'. :) the shirts we have find out more about asian bears here!



back to the waterfall. unfortunately, chris and i dont have so many pics of the waterfall because chris (and the bag he was carrying with all our stuff) fell in backwards into a pool (the first level of the waterfall) while he was attempting to take a picture. our camera died in this accident, but everything else (including chris) was soaked, but fine. chris was grumpy after he fell in and didn't want to go swimming anymore, so we ended up just hiking up and exploring a bit before heading back. we did make our way up to the top of the large falls though on a somewhat obscured path and were able to look down on the park and the falls - next time we go back we're definitely swimming there!



after returning from the waterfall, we were hot and unhappy, but ate a great lunch at dao fa cafe (i had cobb salad and chris had a chicken curry sandwich). the power was out in luang prabang all day and i suffered through a relaxing (but really hot and sticky)massage at khmu (an ethnic minority in laos) 'spa'. when my massage was over, we still had some time before dinner so strolled around, stopped in at joma cafe for a drink and pastries, and spent an hour or so doing crazy shopping for souvenirs at the night bazaar. exhausted, we enjoyed a fab dinner at the apsara restaurant (attached to our hotel). i had a refreshing salad, fish cakes with tomato basil sauce, and chris & i shared mango and sagu (like tapioca) in coconut sauce. i also enjoyed a beer lao before turning in for the night.



last (half) day in laos. before boarding the flight back home to chiang mai (which was much more turbulent and made me doubt whether i wanted to travel in prop planes again), we walked the city and made a trek out to the local Phou Si market (about 4 km away) in the heat. we were super disappointed in the market (i had heard there were really awesome textiles there, but it was mostly vegetables and a few textile stalls and then some other stuff) and i had gippy tummy, so we took a tuk-tuk back into the city. there, we bought a beautiful hmong batik hanging from mulberries, a local NGO supporting village crafts, sericulture, and art. we also found an awesome picture album at yen sabai, started by a 25 year old laotian in a small house, and ate a traditional lao lunch at tamarind cafe, a restaurant started by a young couple (the man is lao and his wife is australian and writes about lao food and history). it was really awesome to have a lao meal since many of the cafes and restaurants in luang prabang focus on foreigner food and not many places serve local fare. there is also not as strong of a street food culture (noted by caroline, the co-owner of tamarind, as well). chris and i got plates to share and loved the different dips (esp. this tomato based one), enjoyed with the dried river vine/seaweed and sticky rice, ate buffalo sausage (YUMMY, but im obsessed with sausage up here), pickled bamboo and ginger, and 'heavenly' buffalo jerky (like moo pan). i also really appreciated the iced cinnamon bael tea and enjoyed reading about the history of lao food in the menu and hearing about it from caroline. i DEFINITELY recommend this place if you're headed up to luang prabang.



and that's it! we've been back in chiang mai for a few days and a lot of stuff has happened, but that will have to wait for another blog entry. work is going well though, and i'll update soon. :)

livin' it up in luang prabang, laos

for the uninitiated among my readers, the art of a visa run can be very important if you're planning on spending any significant time abroad. there are tons of different types of visas (each letting you stay in the country for a specified amount of time) and when your visa expires, you need to find a way to get a new one. there are a few ways to do this, including

1) Go to immigration and apply for an extension and/or a new visa. this inevitably takes a decent amount of time (waiting at immigration, being told to come back later because they didn't get your number, them telling you your paperwork is insufficient) and also $$.

2) Leave the country and then come back into the country. When you come back, you get a new visa! chris is on a sort of spouse-visa where he can get a three month visa every time he leaves the country and comes back. since we last left the country in december for our weeklong trip to vietnam, his visa expired this past week. we decided to go to laos for a four-day weekend to renew it :)

on a tip from my college friend judy chen (who lived in laos for a bit, but is now back in the US), we booked a package through lao airlines that included a two-night stay at the villa santi , a converted french villa that also has a resort attached outside of the city. although i had stressed that i wanted to stay in the city, we were told when we arrived that the hotel was full and that we had to stay at the resort (about 6 km away and accessible by shuttle bus only). the resort turned out to be okay - bigger rooms, nice grounds, etc. the first night we were there we arrived around eight, ate lao food for dinner at the hotel restaurant, and watched some tv (yay cnn & hbo) before heading to bed.

First full day in Luang Prabang (3/24):

buffet breakfast at the hotel which included a mix of western and lao foods. i had some baguette with jam, an omelet with ham and local mushrooms, and homemade yogurt with fruit salad. chris (as usual) ate a little of everything in the buffet. :) the coffee is fantastic in laos and is made french style, carrying on some of the culinary traditions post-colonial times.

we boarded the 9 am shuttle to the city and then walked around for the next twelve or so hours. snapshots of the day:

luang prabang is a (somewhat) easy city to navigate once you get your bearings. it's located on a peninsula between two rivers (the mekong and the khan) and filled with temples, much like the old city of chiang mai. people aren't really into using names of roads to navigate, and the same stretch of road changes names every couple hundred meters or so depending on what temple is nearby. A former capital of laos and one of the cities that was essentially untouched by america's 'secret' war during the vietnam era ,luang prabang was named a UNESCO World Heritage Site in 1995. im not sure what that means, but i think that it restricts the amount of development that can be done within certain zones of the city. some people are happy about this (preserving heritage, etc) but some are unhappy because they feel that they're not allowed to reap the rewards of development (ie concrete houses - you can't tear down old wooden buildings). interesting debate, for sure.

in any case, some of the many places we visited on our first full day:

1) Temples. Two of the most famous temples we visited (among at least a dozen) included:

Wat Xieng Thong (a 16th century temple known for its glass murals, a small 'museum' area housing a former king's funeral chariot decked out with nagas, and its gold facades) and Wat Phou Si, one of many temples housed on Mt. Phou Si overlooking the city. I noticed that many of the wats had the Buddha standing with his palms at his sides and fingers pointing downwards. this is the 'Buddha calling for rain' stance and only found in Laos.

Temples in Laos function as homes (and schools) for young boys and many hundreds of them are sent to Luang Prabang to join a temple by their families at certain ages (some as young as six or seven). Most men in Laos have been a novice at some point in their lives, especially if they are educated. Novices participate in the morning alms ceremony (starting around dawn), where they walk barefoot through the city with their alms bowl and receive food (mostly sticky, or glutinous, rice) from Buddhists who wait on the sidewalk with offerings throughout the city. chris and i participated in this ceremony (or tak baht) on the third day we were in Luang Prabang.

2) Shopping! after discovering a cool booklet promoting sustainable tourism in Luang Prabang called 'Stay Another Day: Laos' , i led chris around to a bunch of cool shops/projects supporting local artisans, fair trade, and the preservation of Lao heritage. two of the shops we visited, ock pop tok (translated as east meets west in both lao and thai) & kopnoi (little frog) had free exhibits about lao culture as well. the first was an exhibit about hmong culture and hmong batik, featuring an elderly hmong woman painting batik onto hemp in the main room, a traditional hmong house, and great information and actual pieces of clothing from different hmong tribes throughout the two-story showroom. the second exhibit at kopnoi focused on sticky rice, its history, types, and how it is planted, harvested, and eaten in laos. both were really educational, interesting, and manageable (in terms of space and offered reading material). i think it's really hard to find a good blend between commercialism and education like that in chiang mai, but maybe im just looking in the wrong places.

chris and i also stopped in at this really cool NGO project called Big Brother Mouse started by an american expat (previously a publisher) in conjunction with local Lao college students to address the lack of children's books available in the Lao language. basically, college students and recent graduates learn all different aspects of publishing (writing, translating (many books are in lao and english), illustrating, layout, etc.) and have published a series of books for readers at all different ages. they're really awesome and chris and i donated some money to help put books in two local children hospital's waiting rooms so kids could have books to read while they were watiing. if you ever go to luang prabang, you can stop in at their office, check out their books, and also help them with english practice/proofreading.

i noticed that there were a lot of really cool local ngo's trying to help encourage either community-based education initiatives (like Big Brother Mouse, which also has cool signs up around the city encouraging reading, responsible tourism (give books away instead of candy to kids!) or help preserve local traditions/artwork. many of these initiatives are started by or staffed with young people and it's exciting to see how passionate they are about their work and country.

3) Chill-out places. chris and i had a snack (tuna cakes with lime aioli mayo, yum!) and drinks at l'etranger, a cool cafe/tea room/library/bookstore before heading to a show at the royal ballet. l'etranger rents books for travelers to read at 20 cents an hr and allows local lao to borrow books for five days at a time for free (to encourage reading!). they also sell books, many relating to southeast asian and lao history, politics, travel, etc, and screen hard-to-find movies (like wordplay!) upstairs in the evenings. i really loved the place and we ended up visiting it twice while we were in luang prabang. :)

4) Art. i convinced chris to go see the royal ballet with me after we saw kids practicing at a summer camp run by performers at the National Museum (the King's old palace grounds, also home to a series of art exhibits in the Royal Lao Ballet Theater). it's really similar to thai classical dance, where people wear elaborate costumes (and masks) and act out scenes from the ramayana. none of the participants talk during the actual performance, with music and song being provided by musicians who sit on the side of the stage. we saw a scene from the ramayana showing how a princess was saved from a giant (who had kidnapped her) by a monkey general, who brought back the princess back to the king (who refused to take her back because he thought she had been unfaithful to him). the princess maintained that she had been chaste and submitted herself to a 'trial by (sacred) fire' to prove her innocence, the authenticity of which was confirmed by three sages who were called to monitor the proceedings. in the end, she passed the sacred fire test and became queen. overall, a decent story, but kinda frustrating that she was the one that had to prove anything (after she was KIDNAPPED by a scary giant!) - it's like women were being held responsible for anything that happened to them (whether it was in their control or not) starting thousands of years ago. ugh.

we weren't able to take many pictures in the theater, but overall, chris and i enjoyed the show (especially the little monkey kids!).

i also super enjoyed this exhibit at the national museum called 'Quiet in the Land'. this was an exhibit that paired mostly American artists with local artisans in Luang Prabang and allowed them to create different types of artwork reflecting their experiences. some of the features of the exhibit included portraits (done in pencil) of different monks and novices, hmong-style embroidery depicting important scenes from one's life, a boat that was built to house meditation in silence, and a short film highlighting different scenes in and around luang prabang with music and short thoughts/commentary. example: 'he said that in laos, there never used to be any written thing marking a person's grave. if people still remembered the dead person, they would come visit the grave and lay flowers and incense on it. when they ceased to remember, then he would cease to exist." the film at this point showed a clearing in the woods where there was a massive pile of flowers and incense (no grave/head stone or indication of who was buried where).

5) Food. aside from tuna cake snack at l'etranger, chris and i grabbed yummy sandwiches and fresh lemon soda for lunch at the scandinivian bakery (french bread & pastries are amazing in laos!). after the ballet, we also ate a fancy lao dinner at the three nagas where we enjoyed sausage, mushrooms and veggies steamed in banana leaves, pork & eggplant curry, and spring rolls.

more updates (on days 2-4 in laos) to come!

when it rains, it pours

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. :)