luck be a lady tonight

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

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

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

weekend

overall, my weekend was nice and relaxing.

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

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

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

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

sunday:

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

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

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

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

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

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

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

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

mo'c mo'l

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

feeling somewhat productive

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

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

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

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

back by popular demand :)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

what i love about america

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

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

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

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

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

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

4. Being able to drive when I feel like it

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

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

7. 24 hr stores like Meijer

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

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

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

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

good times in good ol' geneve

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

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

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

- Long lunch meetings at IOM with thiru

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

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

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

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

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

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

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

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

- Getting giggly on the train back from Montreux

- Swapping boy stories with Roxanne

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

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

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

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

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

me, kim, roxanne, and jen


Golden Paradise Flying Cheesesteak.

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



- Diabolos (Limonade with Peach syrup) at Café Arts

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

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

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

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

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

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

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

- Cereal with strawberries, courtesy of Pan

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

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

Things I won’t miss about Geneva

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

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

Weekend of June 24-25th, 2006

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

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

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

Memorable moments from this hike included:

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

Day Two:

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


overlooking vernazza

Highlights of DaY Two:

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

trying to catch up on blogspot

After postponing our trip to Lugano for a weekend, Kim decided to kickstart us into high gear and sorted out her ticket situation, reserved us some seats on a rather uninspiring leg of the Glacier Express (Italy was much cooler, according to Kim, but we'll get to that later), and committed us to a hostel near the train station in Lugano. Lugano is technically part of Switzerland, but geographically it's essentially in Italy (much like Geneva is essentially in France - check out a map), so it has its own character and is known for being a beautiful lakeside vacation town.

The train ride to Lugano was fine, but a little hellish because we had to transfer four different times or something ridiculous. Kim was well prepared, however, and brought lots of yummy snacks for us to munch on (I was very impressed). As an omen of what was to come, Kim and I accidentally did not get off at Lugano because we didn't see a sign (and misread one that said orarios, which is actually 'timetable' in Italian) and had to find our way back from the next town over, Paradiso. In any case, we eventually ended up at the hostel after getting directions on how to board a bus by a guy in a lakeside stall ('go stand near the choo-choo'…we figured out what he meant when we DID see a choo-choo, or small tourist train that runs through the town on the normal streets). After checking in, we threw down our stuff on some bunks, and went off to explore Lugano. We could not find this funicular that Kim's guidebook was talking about (yes, we later discovered it the day we were leaving - it's in the middle of the train station) and so took the bus into town, walked along the waterfront, and devoured some spaghetti. Later on, we walked through a park, window shopped, and noted that besides really expensive brands, Lugano was also really into selling lingerie/swimwear (sometimes hard to discern which was which), with many sets starting around 200 USD. Following some aimless wandering, we ended up at a café/bar where people were really excited about the Italy vs USA game. We each ordered what turned out to be really strong drinks, people watched (I was impressed that a single American dude was able to integrate himself in with a European couple and other single girl), and wondered why our waitress was dressed like a porn star (dyed red hair, pigtails, italy cropped t-shirt, skirt). Although we tried to crash early, we both didn't sleep very well because of annoying ass people coming into the hostel loud, late, and drunk. I was annoyed with two German girls in the bunks above us because they kept whispering and giggling until 4 am. Some dudes also came in and slept with their girlfriends and were smelly.


town square in lugano

Day 2:
We ended up booking it in the morning to escape such smelly peoples and caught a ferry to a neighboring seaside village, Gandria.


kim noticed this pic on our ferry, informing you that if you brought your dog on the ferry and it was little, it was free. however, if you had a big dog, you had to pay 50% of a normal fare. quote from kim: "i think all dogs aspire to be gratis dogs."

Gandria was totally cute and built into the mountain, so all the streets were narrow, made of cobblestone, and kept winding upwards. There were also a lot of cute restaurants where you could sit on a terrace overlooking the water (we ended up eating lunch at one of these), some small local galleries (kim bought a painted platter for her mom here), and a paved trail along the mountain detailing the path of how olive oil was made. Although Kim and I originally had grand plans of checking out a cathedral and a park, we ended up running into a place kinda similar to Bains des Paquis in Geneva, but smaller. Essentially, it's a deck where you pay an entrance fee and can rent beach chairs or beds with a roped off swimming area in the lake, a café, etc. Because it was really hot, we decided to spend the remainder of our time laying out, swimming, and talking. Kim reminded me to mention that we were joined by two elderly ladies, one of whom had a tremendous amount of plastic surgery done on her face and was really very unattractive, and another, who was some kind of vip since her chair was 'reserved' and she acted like the lifeguard was her slave by having her move around her umbrella. This aforementioned lady was also unattractive but was even moreso because she insisted on sunbathing topless and in a bottom that was uncannily close to a G-string. Most unfortunately, she was lying directly behind us with her legs facing towards us, giving us a most unwanted view of her crotch area. Needless to say, we tried to turn around as little as possible throughout.

The afternoon overall was super relaxing, but we had to rush back to get to our train. We had stored our stuff in the hostel and Kim got super pissed off when these little girls (maybe high school age?) tried to block us from coming in to get our stuff and did not help us get out (they had locked this door that was supposed to always remain open). We made our train, but ended up missing a connection later on as we didn't realize that the next train we were supposed to get on was in a different station. I was stressed since I had to get back to Geneva for the beginning of my weeklong seminar (Health Policy in a Globalizing World), so rushed back to Lugano on the train to see if I could catch the last train to Zurich. I ended up missing it by 5 minutes, so crashed at the same hostel near the train station (but in a private room). I ended up leaving around 6 am the next morning, arrived in Geneva at 12:30, and rushed home to change quickly before meeting up with my fellow fellows at the Global Fund to Fight AIDS, TB, and Malaria. The site visit was okay, but it was cool to meet the new arrivals in our group. At night, a few of us girls ended up going to Café Arts, where I got a yummilicous salad, but was annoyed about being attacked by one girl who said, "Why do I get the feeling that you don't want to hang out with me?about acting like I didn't want to hang out with her because I wasn't all gungho about waiting around for everyone and just suggested meeting up later after I got dinner. Actually, I was trying to be considerate because I knew I was going to a pricier place and she always talks about saving money, so I threw it back in her face by saying that I didn't want to impose an expensive place on people who might not want to pay that much for a meal. Anyway, it ended up working out, and dinner was followed by some informal chattiness with invited guest Thiru at Bains des Paquis. I bounced early because I was exhausted from travelling, but it was good start to the week.

The past week was a little crazy. We had site visits almost everyday and visited WIPO (the World Intellectual Property Organization), the US mission to the UN, the World Trade Organization, Drugs for Neglected Diseases Initiative, UNAIDS, and others, while also being in class from around 8:30ish to 6ish everyday. Following class, we often had optional dinners, where invited speakers would informally talk to us about their careers, but this made for a very long day (we'd often get done around 9 or 10 pm). One session was held at the WHO, but most of our lectures were held at HEI, a local Geneva University that specializes in international affairs. In addition to the fellows, some WHO staff also joined us and I met a cool Swiss physician who worked in Cambodia for a number of years doing training and health systems work. It was interesting to be in class with older staff, but one woman ended up dominating a lot of the discussion and being very antagonistic to some of the presenters, which ate up a lot of time and wasn't that productive. Later on in the week, one of my classmates took me aside and said, "Tanya, I need to ask you a question." I was a little concerned that I might have done something, but she said, "Am I one of those people that asks too many questions? I'd trust you to give me an honest answer." I laughed and said she totally wasn’t, and she was relieved. It felt kinda good to know that people respect my opinion though, even on trivial matters.

My favorite parts of the course were the modules on trade and health. I realized that my knowledge on IP has increased markedly by just being here, reading stuff, and that I've had some good experiences (seeing the R&D treaty process at the World Health Assembly, for example) and met some fun, interesting, smart people. Even though I got off to a slow start, it's been nice to use other parts of my brain, share stories (mostly with Thiru and Kim), think about how different roles (scientists, policymakers, health care workers, public health practitioners) interact and work (for or against) each other, think about where I can fit in and contribute, and engage in discussion about issues that rarely, if ever, come up in medical school. More updates (on a weekend trip to Cinque Terre, with the director of the Fellows Program and two other fellows) to come.


me and kim (in geneva's old town)




Random postscript (added to interesting things about Geneva): The rage here is white pants…for both men and women. I see at least twenty people a day wearing all forms of white pants, some with their underwear showing. Also, nobody wraps their hoodies or sweaters around their waist here (everything is tied around the neck)…very preppy. I always feel like people are going to play tennis.

overdue entry on london

After being somewhat isolated in Geneva for a few weeks, Chris and I took a weekend jaunt to London. I never normally use the word jaunt, but it just popped into my head (and how often do you get a chance to use that word, anyway?) so somebody inform me if I’m using it incorrectly. I think it describes the whole experience though.

So, as my previous entry stated, we stayed with Chris’s high school friend and his girlfriend in the Earl’s Court area. Following a delayed flight, a train ride on London Gatwick’s express, and a go on the Tube (London’s Underground), we got in really late on Thurs night and grabbed dinner at a local restaurant in the area, Balard’s. I think the bill came out to over a hundred dollars for three people and we just had one entrée each and a beer. Intro to the pound, where the exchange rate was 1.8 USD to 1 British Pound. I tried to think of things in dollars so it wouldn’t seem so bad, but it was super expensive! Go with the flow, though.

On Friday, I made Chris attempt to show me around, so he took me to see Big Ben and Westminster Abbey. He didn’t really know the significance of either, so I read about them in one of many tourist guides we had along. We also attempted to go shopping in SoHo and ate fish and chips at a local pub. Other highlights of the day included getting passport pages added to my passport at the local US embassy (there is no embassy in Geneva, just a consulate) – they just tape pages labeled A-Z in), dragging Chris into a Dali/Picasso exhibit and being a little freaked out, but enjoying the sculptures with soft clocks and drawers coming out of people, meeting up with a college friend who’s studying at the London School of Economics for cheap Korean food (yum!), where our waiter refused to acknowledge our order unless we spoke to him in numbers (example conversation with Chris follows), seeing the streets overflow with people at local pubs (everyone just stands outside with their beer on the pavement), and riding in a British taxi. Also, missing our reservations at Kensington Roof Gardens with our hosts and standing in a ridiculous line to get in with no other people of color. I guess reservations and guest lists are rampant in London, but this is probably skewed since this hs friend was all into going to exclusive places. Back to the Korean waiter though:

Tanya: Let’s order another plate of bu gol gi (marinated Korean beef) and share it.
Chris: OK (calls waiter over). Hey, can we have another plate of bul gol gi? (points to plate that we already have on the table, which is shaped like a cow, in case you didn’t know what you were eating)
Waiter: Number 44?
Chris: Um yeah, bul gol gi. (We have no menu at the table)
Waiter: Bul go gi? Number 44? This? (points to plate of bul go gi on the table)
Chris: Yes, we’d like another order.
Waiter: Number 44?!

This goes on for a few minutes. My college friend Anna and I are like, what’s going on? It was hilarious, but we did end up getting another plate. Yummy. This was our cheapest meal in London, and I think plates went for between ten and twelve dollars. At dinner, we caught up, talked about her degree program and compared her educational experience to the US, shared some Swat gossip, and talked about social justice. Following that, we walked around and got dessert and coffee at a café. Good times, fun stuff.

On Saturday, we hung out with high school friend the whole day. His gf, who is German, stayed home because she had a toothache. We went to a food market reminiscent of Reading Terminal Market (but much bigger!) where Chris ate a turkey sandwich with cranberries and applesauce (year round Thanksgiving at this food stand), consumed many food samples, and walked along the River Thames. We visited the Tate Museum of Modern Art, which is housed in an old converted power plant, and high school friend made fun of most of the pieces, but I thought it was on the whole interesting and kinda wandered by myself. I also browsed an outdoor used book sale and Chris bought me a cute necklace at a little boutique while hs friend was getting a 15 minute Swedish chair massage. Later, we stumbled onto an outdoor fair that was talking about sustainable development and healthy eating choices (mostly for kids, but it was a family affair), enjoyed a view of the city from a balcony bar, ate some pasties at a pub where we noted three groups of annoying girls having hen parties (British bachelorette parties), and caught the night’s showing of STOMP (some really creative noisemaking and rhythm here). This was a busy day, and we ended it with some Belgian food (mussels, sausage, mashed potatoes, cheese, beer) at this industrial looking restaurant where you sit on benches (like in a ski lodge) in the basement. Chris had to leave to go back to the US early the next morning due to news of his grandfather’s passing, but I had a little time before my flight back to Geneva, so I explored Camden Market (a British Chatuchak, or a series of huge outdoor markets!) and ended up picking up a Punkyfish hoodie and grabbing some quick Thai food. All in all, it was a good time, and I think it would be fun to go to school in London…if Chris made money ;). Seriously though, salaries are generally commensurate with the cost of living (this is also true in Geneva, where UN employees get crazy benefits and make tons of cash)...unfortunately, there is still a huge poverty problem in London, many kids live below the poverty line, and homelessness/poor housing conditions are rampant (we met many street campaigners on these issues and saw billboards in the Tube trying to raise awareness :) ...see, it worked, since i still remember it a few weeks later! too bad med school didn't work like that for me ;) ).

shout out to everyone who is studying for Step 2!!

plainpalais, a cement park

In the big cement park known as Plainpalais near my house, they've set up a big screen TV, speakers, and a bunch of food stands for the month of the World Cup. I think most every game is played on it and Geneva peeps come to hang out, hook up, and watch football. Since there's a lack of food stands in general throughout the city (no cheesesteaks or breakfast sandwiches here), it's a pretty good (if expensive) place to pick up some limited menu items from a variety of vendors. Interestingly, there is no Swiss food stand, but there are Brazilian, Afghani, Turkish, and Thai people representing.

Since Plainpalais is so big, the World Cup setup only takes up part of the cement/rock area. Over the weekend, for example, there were two other events going on in Plainpalais, including a Sustainable Development Fair (a couple of tents with different NGO's and other orgs, and a playground for kids built out of cardboard boxes) and a Dog Obedience Fair. I happened on the Dog Obedience Fair when I was walking to meet my friend Kim at Café Remour. It was semi hilarious because the announcer was speaking in French and it didn't seem like the dogs were really obedient as their owners tried to run them around this makeshift ring. Also, a poster advertising the event showed a dog leading a human on a leash. I feel that more often than not that's what's true, especially in Geneva.

Other highlights of the end of last week/ this past weekend included:

Accidentally ordering this yummy drink at Café Remour with Kim, which consists of iced coffee, tea, and ginger. We think there's more tea than anything in it though because it looks just like iced tea, but it's pretty yummy.

Meeting my roommate's boyfriend whose philosophy on life can be boiled down to two words, which he says often, and states that it is an 'expression of energy'. These two words are fuck yeah! Also, hearing his views on how most criticism at a job is bs, and that most jobs are bs. Agreeing with him but not as energetically.

Late night conversation and dessert at this coffeehouse on Plainpalais, 'Central Perk' (straight out of the TV show Friends), with Kim. They have the font for Friends and everything on their sign..i wonder if this is a copyright or trademark infringement ;)

Going out for coffee with my roommate, her bf, and this other couple who are also b-school grads from this famous school in France. Quietly eating ice cream while listening to this one girl complain about how she works like 12 hr days as a consultant for McKinsey and has to travel all the time and doesn't get paid enough salary. Thinking in my head (but not saying out loud), residents work hella harder than you (30 hr shifts, hello) and probably get LESS THAN HALF your salary. Also thinking, when she stated that she LOVED selling stuff, and wished her whole career was in sales, that I wanted to barf. Later on, thinking that if she liked sales so much, maybe she should go into selling something that was useful, like condoms. A comment from one of Kim's acquintances comes to mind...this is a law student who told Kim (who is obviously going into public interest law) that people's worth to society is commensurate with their salary. Um, WHAT?! That means the whole Global South could just disappear because their earning power sucks compared to other people in the Global North, even if they work hella crazy hours. This is frustrating to me (obviously) just in terms of the lack of political will to address HIV/AIDS and saying we don't have enough money to support treatment even though first line ARV's can now cost as little as 135 USD a YEAR. Not treating people to me is like saying, your life is not worth even fifty cents a day, sorry.

Dancing and enjoying a free concert (this is Thurs night) by Olodum, a Brazilian drumming group with singers and some other instruments (like saxophone), also in Plainpalais. Meeting some new interns who attend pharmacy school. One girl from Canada was a little spaz and was like (this is a serious quote), "Wow, this is sooooooo fun and exciting!" "I didn't have friends before, but now I do (referring to us)." I was like…do I know you?. Another intern from Univ of Illinois Chicago who expressed frustration that everyone spat out their resume when they met her and admitted she felt intimidated because she didn't go to some East Coast Ivy League School. I was like, screw them, and be confident in yourself. At this same event, being disgusted when ppl greeted other ppl with saying such as, "Hel-looo Princeton!"

Eating mango jasmine sorbet from the bakery/sweet shop downstairs that my roomie bought for dinner over the weekend.

Having a long lunch with 'droptop' (this is his alias) at a yummy cafeteria near the WHO whose salad bar kicks WHO salad bar's ass. I had WHO salad bar today for lunch and was severely disappointed and upset. I think it set the tone for the rest of my day, where I spent like six or seven hours printing out patent documents and doing database work. Droptop is fun to talk to and text msg; he also offers interesting insights and knows many things.

Discussing mental health issues with a couple people this weekend. My friend Kim told me that George Washington Univ expelled a student after he went to the psych ER seeking help for depression (he was depressed after his close friend committed suicide while he was outside his dorm room trying to break in). They said he broke the code of student conduct by participating in self-injurious behaviour, or thinking about it, or something totally on crack. I'll put the link to the case (he's suing them now) up here later if I can find it again (actually, Liz put it in the comments, so go there if you want to read about it). This is TOTALLY frustrating to me since people are punished for seeking help. What the hell kind of supportive learning environment is it when colleges and universities expel students for seeking help for mental illness??

things that piss me off

Lunch yesterday

I had lunch with a few other interns yesterday. Two of the interns went to Princeton for undergrad, one went to Dartmouth, and I'm sure anyone who's reading this knows I'm a Swattie. Part of the conversation centered around the eating clubs at Princeton, which I didn't really know about before, but now, thanks to this conversation and an informative IM session with Bryan (where he read the wikipedia entry on it), I do.

From my understanding, you apply or join an eating club and that's where you eat. I asked about eating at other clubs, but you can apparently only do that if you switch with someone in that eating club. Sounds like a fraternity or some weird exclusive thing to me. The two Princeton people at my table tried to guess which eating club the other one was in (turns out they were in the same one, but they're different ages so didn't know each other before), talked about other people in their eating clubs, and explained to me that it's super difficult to have a social life without being in an eating club. Also, people who aren't in eating clubs are 'independent'. I noted that Swarthmore had one cafeteria to promote equality and socializing. There was an awkward silence and then they ignored me after that. The conversation continued with the 'name the famous people in your class' game. For some reason, I was totally unimpressed.

After lunch, one of the Princeton people talked about how her little brother went to Duke and was a frat boy and how she was totally not like that. Um, exclusive eating club?

I love Swarthmore and rave about it often but I don't feel the need to prove anything to anyone. At that table, all of us went to elite colleges, and we all knew it, and I had no understanding of why we needed to rehash about how hard school was or how elite we were or whatever. This experience made me not want to eat lunch with other people anymore.

After dinner drinks

The program I'm on organized another happy hour at Les 5 Portes for people to meet up. There were a lot of Global Health Fellows there this time and I met some new people, including some new med students, which was nice. While I was there, I saw a cute Asian dude with good style outside on the terrace and thought, he must be American. Later, I noticed my friend T. join him and waved at him through the window. Because of the glare, T. gave me a half wave and then looked away. I was slightly embarassed because I thought he might not remember me or not want to say hi, but remedied the situation when I walked outside and said hi to him and he invited me to sit down. His friend was American (and a Midwesterner to boot!) . We had an interesting conversation about intellectual property related things, Thailand, intense college tours in the states, high school students paying to go on crazy volunteerism tours, being an expat, my brother's crazy Watson fellowship, and more.

Later, I walked home with T. He relayed to me a conversation he had with another intern on my program, as a bunch of us were freezing our butts off at the lake after happy hour.

T (sarcastically): "So, (intern name here), have you eradicated polio since we last talked a few weeks ago?"

Intern: (in all seriousness) "Actually, yes, four or five countries have fallen off the map (meaning polio was eradicated there). We're going to eradicate polio in the next two or three years, and I would like to stay in Geneva to see it…."

T (tries very hard not to laugh).

Intern continues to tell T about the WHO and his or her (why doesn't English have a neutral gender term for people?) life plan. T has worked at the WHO before and feels sorry that this person is smart but has these grand feelings and believes that s/he is personally responsible for anything that is going on.

I feel old and jaded a little but am 25 and haven't really done so much but at least have somewhat of a clue of what it's like on the ground. I think people respect that a lot actually. T and I talked about how it's important to take some time off, get some perspective, do your own thing. I'm incredibly grateful to the opportunities I had on my Fulbright and felt like I really made the most of it…I miss my mentors but also those - many of the sex workers and IVDU's (IV drug users) who opened up their lives, and hearts to me, random Thai American med student.

Lunch today

I went to lunch a little late because I wanted to check in with Chris (he just got back from DC, where he attended his grandfather's funeral). Apparently I missed lunch with one of the 'big bosses' at WHO (again, trying to conceal identities here). I actually was supposed to meet him this morning since I'm working in his division but missed the meeting due to a prior commitment. Actually, it wasn't really a prior commitment, but it was the most exciting part of my day, where I had a long conversation with a Brazilian physician who is on the team that's writing the new WHO guidelines on ARV treatment. He basically gave me a personal lecture on the background of access, the new treatment guidelines, and other cool things that I'll talk about later. He also introduced me to this cool Brazilian pharmacist. Anyway, to get back to the theme of things that piss me off, I cut and pasted this googlechat I had with my friend Kim:

Me: I almost got in a fight with another intern (he's Indian) at lunch because he was saying how desi kids who dress in hip hop gear bother him
Kim: why, not everyone has to be a preppy med student type
me: and this other nepali girl, was like, "yeah, my cousins do that, and some of them even get their hair braided, and im like, i dont know you"
and then he was like, "two guys in my bhangra group at yale are like that, they freestyle and breakdance and then dress like all thuggish"
i was like, "What's wrong with that? I used to dress like a punk all the time in high school, not everyone has to be the same. You shouldn’t judge people by the way they dress."
Kim: plus that's kinda racist-y, is he suggesting that hip hop is only for black people?
me: and he was like, well, it's natural to
Kim: and bhangra i suppose is only for indians?
me: judge people if they're not conforming to the norm
and you know, we were raised a certain way
blah blah
Kim: ooh i don't like that at all
me: i was like, yeah, but just because you were raised a certain way doesnt mean it's right
and i waslike my brother dresses in a hip hop style i guess and
GRRRRRRRRRRRRRRRRRRRRR
Kim: yeah really, get over yourself, the world would be really boring if everyone who happened to be the same color aspired to dress and dance and talk and eat exactly the same
1:25 PM me: anyway
then they stopped talking to me
Kim: i suppose i'm only supposed to be into country music or something?
that's icky
me: i dont get how ppl are like that and then have grand goals of saving the world. im like, you judge other yale students for dressing in baggy clothing
what the hell
what if your pt comes in with clothes you dont approve of
Kim: well it's like we were talking about how a lot of that 'saving the world' stuff is actually condescending, like people think they have SO much to offer, they're SO much smarter and more together than everyone else
me: sigh
i kinda wanna save some ppl
anyway, i dont know if im being a huge bitch
Kim: no, you're not, he's being immature and self-involved and probably insecure
me: i feel like i get pissed off talking to everyone except you

ok, enough pissiness. im not including an im conversation i had with sural here about a contentious post on the AMSA global health listserv re: calling your house reps to oppose continued funding of abstinence only education, but may touch on that later. However, one funny thing is that there is now drama between the interns and another intern is pissed off at LW (those of you reading this who know her can chuckle to themselves). Apparently, when LW and another intern went down to lunch today, they were approached by our 'big boss' while getting water, who asked if they wanted to have lunch with him. They agreed but then other intern who wasn't included approached LW and was like, "So, when are you going to invite other interns to your special lunch meetings?" and "When are you going to stop putting yourselves in these special situations?" Kinda hilarious in a way. I'm staying out of it though.

Next post, funny moments. Maybe some London related things as well.