leelawadee

the leelawadee flower (known as rangipani in English) has emerged as a theme from my short six-week stay in thailand. a super fragrant flower, it was previously named lan-tom and not grown domestically because it was associated with temples and its name also reminded Thai people of ra-tom, which means sorrow. H.M. Sirinthorn renamed the flower to leelawadee, and since then its popularity has soared among Thais throughout the country.

my leelawadee experiences have included:

1) Going to Leelawadee spa with Karyn, a good friend from TTAG. There I enjoyed a great foot massage and also a Thai-style facial, which involved some sort of honey scrub.

2) Eating at Leelawadee restaurant with Nan and P'Dong around Ramkhamhaeng - super yummy food, live music, and nice Thai-style decor (refer to previous entry).

3) Receiving a Leelawadee Madam Heng gift set (two bars of soap, one shaped in the form of a leelawadee flower) from my mom's seamstress, who i also visit when i come here. This gift set commemorates the King's 80th year on the throne.

All these Leelawadee experiences happened during different weeks of my stay, but constantly reminded me to appreciate the vast amount of natural beauty in gardens (even within the madness of Bangkok).

nakhon phanom

im wrapping up my time here in Thailand and have had the fortune of going on two work-related visits to Sa Kaeo (near the Thai-Cambodian border) and am currently writing from Nakhon Phanom (near the Thai-Laos border). the visits have been super short (one night, two days max) but useful; i've gotten to tour the labs and find out more information re: the Binax project i'm working on (see previous posts). while touring the lab at Nakhon Phanom provincial hospital today (~350 beds), it occurred to me that i've never toured the lab at UMHS or any US-based hospital. perhaps this is something i'll look into when i'm back on my path/ID elective at Michigan.

Nakhon Phanom is a border town and very chill. after we arrived at the airport around 5:30 pm yesterday, we took an hour-long 'boat cruise' in the Mekong River, complete with karaoke and fried pork balls. it was striking to compare the two riverbanks, with the Thai side being much more developed than the Lao side. from the river, you can see many temples (wats) and also this huge church that runs a school (on the Thai side). the lao side is mostly small huts and also a small fisherie where it seems that fish swim in (but then can't swim out). at the big pier on the lao side, i was notified that there was a Lao Duty-Free store which primarily sells liquor. Thai and Lao people can freely cross the border but can't spend the night (same as Cambodia, and they can only stay in the province bordering the country of origin).

after the cruise, we ate dinner at this pub/restaurant named O-HI-O with live music (basically two dudes with guitars singing cheesy thai songs - common throughout the North, and also Chiang Mai). the local staff we were with were amused that i was actually born in Ohio. across the street, this huge long tent was set up with a stage for a wedding. it appeared as if some sort of talent show was going on, but i was informed that was part of the wedding, which got me to thinking that it would be amusing (albeit somewhat painful) if our weddings were talent shows as well.

after dinner, we got coffee at this cute coffee house and i got a nighttime tour of the 'city' which included a stop at the movie theater (which was closed for the night) - a movie is 40 baht (a little more than a dollar) and there are two screens. although i love bangkok, i could see why it would be appealing to live in the provinces, and appreciate the slower pace of life here.

this afternoon, i'm going to visit a famous temple in the area (wat that phanom) and also Ho Chi Minh's house in this Vietnamese farming community here. who knew that Ho Chi Minh spent years hiding as a farmer underground on the Thai-Laos border while plotting Vietnam's independence from France? apparently, the original wooden hut was eaten by termites, but they've rebuilt it. border history is really fascinating!

ok, off to lunch now. more soon!

working at the ministry

it's a little ironic that the shortest amount i have in thailand is the one where my mentors have given me the most (defined) project and work. due to crazy scheduling issues brought about by my own disorganized life last year, im only here for barely six weeks on the OC Hubert Fellowship, a program sponsored by the CDC Foundation. i am learning a ton and really wish i could stay here way longer! a short run-down of the project:

the project im working on is looking at the utility of Binax testing to detect Strep pneumoniae. S. pneumo. is one of the leading causes of death in children under five (a vaccine is available, but it's expensive for this part of the world) and also affects tons of adults. unfortunately, it's a tricky bug and hard to culture because it likes to autolyse itself after 24 hrs (or less). enter the Binax test, which is an immunochromatographic assay (think pregnancy test, with two lines - one control, one appearing if it's positive) that was created to detect S. pneumo. in cerebrospinal fluid (CSF, or spinal tap fluid) and urine. however, someone came up with the idea to try and use it with the blood they were already getting for blood cultures here as part of a larger pneumonia surveillance study. preliminary results show that the Binax test is really sensitive at detecting S. pneumo. and often will be able to find cases that have negative subcultures. today i'm visiting a provincial lab near the thai-cambodia border and got to tour the hospital and facilities, see how the lab is run, and collect some important information. i also got the chance to speak with some research nurses about hiv/aids, answer their questions, and watch them consent and enroll some patients in this other respiratory pathogen study. it was refreshing to see that they respected patients' wishes to refuse enrollment, although i still find it much more difficult to say no here as a patient (especially if you're hospitalized and don't have a lot of money).

in any case, i really like the office where i'm working as a whole. i have two mentors, an epidemiologist and a physician with an MPH, and they're very supportive and task-oriented, which i find refreshing after previous experiences here. i usually meet with at least one of my mentors everyday or every other day, am learning some basic SPSS skills to analyze data, and feel helpful because i can help bridge the thai-english divide (although most of the staff speak excellent English). the office where i work is housed in the Thai Ministry of Public Health (Thai MOPH) but it's part of the International Emerging Infections Program (IEIP) within the Thai-US CDC collaboration. TUC seems pretty cool to me so far and has made a big difference in these two provinces where the pneumonia surveillance activities are occurring by building lab capacity - the hospital im visiting in Sa Kaeo today just got a PCR machine last month! i'd be interested in seeing how the improvement in diagnostics have impacted clinical care, as the head lab person i talked to today noted that their ability to diagnose a common pathogen like S. pneumo. has increased dramatically (they used to only successfully culture one or two cases a year, and now it's close to 3% of all blood cultures done! i very much appreciate the chance to visit the sites in the provinces and am getting a much better global view of the work that's going on with the Thai-US projects (and hope to be more involved in the future!)

more work updates later. last random fact: did you know S. pneumo. is really prevalent in the Arctic Circle? me neither, but apparently the poster we're preparing is being held in Iceland this year because it's heavily affected by S. pneumo. (and they always pick locations based on where the pathogen they're focusing on is super prevalent). kinda cool, though iceland seems to be a super pricy place to have a meeting!

back in bangkok

after a year filled with ups and downs, i returned to bangkok & thailand. the last time i was here, i was leaving my fogarty site in chiang mai, feeling super nervous (but excited) about returning to clinical medicine as an M5, and looking forward to the match. it seems that things do indeed come full circle as i am in a similar position this time around, although i am only spending six weeks here instead of many months. when i return to the US in a month, i will be an M6, looking forward to my last (real) clinical elective, ER at Henry Ford, and getting ready for the match (again). i feel like this scenario may repeat itself again before i start my intern year, but we'll see.

since my fulbright year, thailand has been a bedrock for me. it was the place where i found a connection to my past, where i became proud of my cultural heritage instead of trying to hide it, and where i experienced a small sense of loss and disappointment that our generation was no longer made up of families with eight or nine siblings (as my parents' was). thailand was also the first place where chris and i really spent time together, where we traveled, where we ate a ton of food. thailand was also the first place where i really started to understand the human effects of poverty, of HIV/AIDS, of the tragedy when people died of preventable illness. thailand made me realize that difficult issues like drug use and commercial sex work and corruption were real and affected real people, people that i knew and respected and loved. thailand made me appreciate lots and lots of shades of gray. thailand made me wonder why it was so physically easy to move back and forth between the Global North and Global South all within a block or a city or from the capital to the provinces or especially to a neighboring country. bangkok reminds me of what it is to have so much and so little, exemplified by a series of thoughts i've had since being back:

1) Bus fare

bus fare has gone up a lot since i started coming to thailand, and another fare hike was recently approved, drawing outrage from the working poor who need to use the bus system to get around. to put it into perspective, the cheapest buses used to cost 3.5 baht for a trip, but now will cost 8.5 baht (up 1 baht from previous fare increases), and because most poor people need to transfer at least two or three times, this seemingly innocuous price increase can easily amount to over 100 baht a month.

the subway and skytrain, both of which i often use, are quite expensive compared to the bus system & don't reach a lot of areas of bangkok. although i often try to take the bus, it is definitely a choice for me and i can easily take a taxi to get where i need to go. for example, i usually take a taxi to work since it's most convenient and it costs me 80 baht for the fare and 50 baht for the tollway (necessary to save about an hr's time sitting in traffic). to put this into perspective, the minimum daily wage in Bangkok (which is the highest in Thailand) is 194 baht a day, or a little over $6.

2) women and children

the friend im staying with works in the field of child protection and we've known each other since our fulbright days. during her fulbright, she helped set up this income generation project in one of the biggest slums in bangkok, klongtoey, and it continues successfully to this day! it's basically a women's group that makes really cool (mostly silver) jewelry (amalee buys all the supplies from jatujak, one of the largest open air markets in Asia, and they work together to identify and make new designs). amalee meets with the group every weekend to collect the pieces that the women have made the previous week, distribute new materials for pieces to be made in the coming week, and pay the women for their work (they can also take out small loans). the women also work on finishing up jewelry pieces it's meant to be supplemental income, and it was cool to meet many of the girls and women who participate (ranging from age 12-13? to 40's). it's also a forum for the women to discuss issues in their lives, which mirror many women the world over must deal with - domestic violence, child care, raising children alone, patience, silence, love.... next week there is a thai craft show where they will go and sell their jewelry. i will post pics and other info later!

3) natural disaster

within days of my arrival both cyclone nargis and the earthquake in beichuan devastated burma and china. if the burmese haven't suffered enough under military junta rule, the (lack of) response to those affected by the cyclone only highlights their plight and the continuing human rights abuses that continue to happen under this regime. to help people that have been working in burma (and also support the free border clinic run in mae sot), please click here.


4) the english expectation

as a native english speaker, i often feel that i become immediately more credible just because of my ability to express myself in a langjuage that i'm comfortable with. in thailand (and much of asia) people often don't want to 'interrupt' or 'cause trouble' by asking questions or saying they don't understand. the first week i started at my internship i wasn't sure what was going on, but we had an epi talk about the roll-out of influenza vaccine to people ages 65 and older throughout thailand and nobody wanted to contribute (even though i'm sure they were far more qualified than me to do so). sometimes i think it's unfair that many meetings aren't conducted in thai...after all, we are in thailand.

there's also a divide in development work and agencies between local hires and those who come to work from elsewhere. my friend has noticed this in the UN and ive also noticed it in various agencies - all admin staff (secretaries, etc) are thai, but there are few professionals that are thai - or even speak it. this leads to a thai-non-thai divide, resentment, and difficulty trying to navigate being thai-american in a western vs thai environment. more thoughts on this later!

ok, im going to try and be better about blogging. next update: work and play in bangkok!

hope and inspiration

ive been fortunate enough to listen, learn, and be inspired from various people the past few weeks. here are a few scattered thoughts about these diverse encounters:

today, chris and i joined thousands of other people in Crisler Arena to hear His Holiness the 14th Dalai Lama give the Peter Wege Lecture on sustainability. we got there early and had pretty good seats showing a profile of the Dalai Lama. even though we were all packed in, i immediately got the feeling of compassion - or loving kindness - that i was in the presence of someone at inner peace. the dalai lama was humorous, was humble, and most of all, he was real. i think that's one reason that i've been kept grounded in the faith of my parents, in Buddhism: like the Buddha, all those who provide us with advice or direction are real people, and they embrace their own humanity. some points the Dalai Lama talked about in his lecture (in no particular order) included:

-the gap between the rich and the poor, and how a lot of our (Western) lives are both unsustainable and overindulgent. he noted the paradox that many of us find ourselves in when valuing material happiness over spiritual happiness - although there is a limited amount of happiness to be found in material goods and the physical world, we fixate on having more, or believe that the next thing will bring us happiness. on the other hand, there is unlimited happiness to be found in inner peace, in compassion, and in ourselves. sadly, very few people decide to nurture or focus on their inner happiness, and suffer as a result.

-valuing humanity by realizing that the potential (in terms of compassion, or "warm-heartedness") of all humans is the same due to the ways in which we are brought into and nurtured into life. i think this was a little different perspective on 'human rights' as ive learned it, but was refreshing to think about as a practical approach to looking at human emotions and values.

-the importance of diversity (in religion) of addressing different times, needs, cultures, and places...although all of them do have similar overarching messages, it is important that they all exist because they provide different approaches for the differing needs of the world. the importance of dialogue in recognizing the beauty and strengths of each belief system. collaborating together, building community to achieve a common good.

-the need for non-violent approaches to solve conflict in the increasingly interdependent world. war as an outdated mode of resolving issues. nobody wakes up in the morning saying, "i hope to make an enemy or get in a fight today!" even with the best intentions, unfortunate things still happen. if you believe in karma, how you react to those situations will determine future events - so it is important to take care of the present, to make choices reflecting the positive effects you want to have in your life (and others).

-the need for community (and the need to see community as including even those who don't agree with you). although he didn't say that explicitly, i thought of it when he was talking about dialoguing and exchange between different religions, and how he tries to engage in that exchange whenever he can. one example he gave of was when he went to the UK and was invited to be a part of this seminar where he had to give lectures about different passages from the Gospel (and inserted some Buddhist perspectives). he described the experience as super challenging (but also fulfilling) as he was trying to lead discussions to believers as a non-believer (and that he had to learn and read the passages the night before as "homework"). many Christians at the event appreciated his lectures and later came to India to participate in meditation retreats and Buddhist lectures. this was a pretty cool example, and made me think about how i (or we) so rarely engage those that are not already part of our value system, and how we should maybe try to do that more in either our daily lives or in the work that we do.

going back to the theme of community, i was really honored to be part of a panel that celebrated the opening of this new exhibit at the National Library of Medicine at the NIH titled "Against the Odds: Making A Difference in Global Health." kevin burns nominated me to be in it, and staff interviewed me a couple of months ago to put together a short profile on me for the "ordinary people" part of the exhibit at the end. anyway, to celebrate the opening of the exhibit, there was a panel of people featured in the exhibit speaking to a few hundred local area high school students, which was pretty cool. i was totally inspired (and humbled) to hang out with and listen to speeches by Dr. H. Jack Geiger, one of the founders of community health centers in the US and co-founder of Physicians for Human Rights, Dr. Victoria Cargill, Director of Minority Research in the Office of AIDS at NIH, and Jeanne White-Ginder, the mother of the late Ryan White. before the panel, i got to enjoy almost an hour of good one-on-one time with Dr. Geiger, who regaled with me stories of S. Africa during apartheid, cases he got during his oral boards, and why it kicked ass to be an emeritus professor. he also gave me some good career advice and was just really honest and down-to-earth.

Dr. Victoria Cargill talked about running a health clinic out of her beat-up car, getting hepatitis as a resident from a needlestick and the inhumane ways she was treated by her own fellow residents, and how she never takes "no" for an answer (fave quote - when somebody says "no" i flip it in my head to "on".... BRING it ON!) Jeanne White-Ginder talked about how ordinary people can be called to do extraordinary things, and how she just tried to be the best mom she could be - before, during, and after Ryan's life. all of it was really super amazing. if you want to see the podcast of the panel, you can check it out here. Also, the interactive online exhibit can be found here. Shout-out to Hanni Stoklosa, who is also featured in a video interview in the exhibit and also online. it is really an honor to be part of a community and a movement that includes really amazing inidviduals like Ryan White and activists from ACT-UP. it is important to remember where we came from, as activists, and as people. sometimes it's hard for me to keep that perspective because i'm always used to looking forward to the future, to the next action, to what we have to do to try and make the world a better place. i realize that i don't think often enough about the past, about lessons learned, about the people who came before us, about their struggles and their strength. watching the interviews with ryan white and seeing his mom speak then, and now, i was pretty overcome by the maturity and the wisdom and the courage a young person like he could summon. it was the same kind of inspiration i felt as a young person reading his autobiography. wow, i thought - i haven't thought about this in a long time, and it feels good to have that connection again, to revisit one's past and connect it with one's future. i was thankful to be given the opportunity to make that connection, and i feel like that's what i hope to do through my writing, for myself, for whoever reads this - make connections between the past and the present, and the present and the future....

lately, for me, ive been thinking a lot about connections, about community, about how my experience fits into the larger human experience as a whole. there was a pretty cool talk by faith fitzgerald titled 'what is a human?' at the global health education consortium conference (follow the link for more of a synopsis on some of the events) in sacramento that touched on parts of humanity, and connections i had with both friends and colleagues there made me really happy - and hopeful - about the future. i spent good quality time with rohan, who gave voice to many commuter night children in uganda, heidi, a ghli'er who recently married a co-worker from cameroon, jen cohn, who is going to lead an awesome global health residency in medicine at penn, and dan, who wrote a kick-ass script for the pepfar call-in i added to the end of my presentation on the global health workforce crisis and bought me a drink at one of his favorite dive bars in his hometown. finally, i also shared fuzzy fleeces (& yummy ethiopian food) with hanni, amsa-ifmsa co-chair. it was good to make those connections and it was good to bring some action and advocacy to a venue which traditionally hasn't been organized in that way. i was approached by more than a few people (academics! physicians!) who said they hadn't done a call-in before, and it was so easy, and they would totally do it again. this was kinda sad, because these people have so much power, but then also kinda exciting, because they realized how easy it was to use that power to make a difference. i hope there will be more organizing and advocacy at ghec in the future, and am looking forward to more student involvement and direction as we move forward.

finally, i just want to say that i feel so blessed (in so many ways) to have a community that continues to inspire me. whether that's through an activist speech making students think about systematic change at a community service awards ceremony (yay rishi!) or posting an inspiring, amazing blog (yay cj!) or helping me connect to a memory of the past (multiple people, multiple ways- more on this later!), i never imagined as an awkward, gangly, angsty teen that i would be surrounded by so much love and hope. besides world peace and access to health care, education, housing, and food for all, im not sure there's much more i could ask for ;)

soros

so, during the madness of the end of 2007, i threw together a soros application and was super excited to get a phone call at the end of december saying that i had gotten an interview. i ended up going through the interview process a few weeks ago in LA, and got my rejection letter from them yesterday. the letter opened with, "i wish this letter could bring you good news. it does not." ouch. luckily, i had kinda been expecting it because their webmaster had put up four names for 2008 winners that was later taken down. however, i figured that because i hadn't heard and winners were already posted, i probably wasn't one of them.

the soros fellowship for new americans is a pretty cool scholarship - they pay half your tuition for grad school and then give you a stipend for 2 years. i was able to apply since im doing the MPP now and it's my first year. it was a super intense application, and i really am thankful to everyone who helped me put it together, including all my friends who read drafts and commented on it, my recommenders, and of course, my IT-savvy husband chris, who used 'Snag It' to make exhibit upon exhibit. although it was the hardest application i've ever done, i don't regret doing it, and helped me put things into perspective around the same time i was applying to the Ford School.

each finalist had two 30 minute interviews with panels of five people at each interview. the panels were made up of previous soros fellowship winners, some people from the foundation, and other New Americans. i thought my second interview went much better than my first, but who knows, really. some interesting things i gleaned from my interviews was that "AMSA is really radical" (answer in my head: what's radical about wanting people to have health care?) and "Don't pharmaceutical companies need to be compensated for all the R&D they do?" overall, the conversation was mostly enjoyable, but i was afraid after the first interview that i didn't articulate myself well enough, and maybe revealed things that caused them not to really like me in the end (like failing step 2). however, i was really proud of some of my answers, including one of the final questions in one of my interviews, which was "What do you want to be known for when you die?" My answer - and I didn't even really have to think about it - was

"I think it would be awesome to implement a policy that would radically change poor people's access to essential medicines, or find a cure for HIV/AIDS..but what I really want to be known for is that regardless of what I accomplished in my career, I remained grounded in the community, and represented their wants, needs, hopes, and dreams accurately. From my work so far, I don't want to be the person who just comes in and tells people how they need to live their lives, or what their interests need to be. If, when I die, the marginalized people I have worked with respect who I am, what I did, and saw me standing in solidarity with them - then that is the accomplishment I would be most proud of."

i got the feeling that some people thought that was a copout, but i really meant it. i'm not sure how the soros values community work (or other grand fellowships for that matter), but it sometimes seems that academia and other institutions don't place as much value on it as 'traditional' work, like how many papers you've published in peer-reviewed journals, or whatever. in some ways, my 'years off' in thailand haven't been successful in that measure, but on the flip side, i'm proud that i had the gumption to go out and seek community work with commercial sex workers, or iv drug users, or just women who needed to get an abortion in a place where abortion wasn't legal. beyond that, the lasting friendships i've made and the maturity i've gained from recognizing that it doesn't matter how old you are or what the social hierarchy or whatever - you can still help others (and mentor them!) in so many ways....that work has been the most important to me. it's made me who i am as a person, and who i hope to become.

in the end, i have to say that i was super disappointed not to win. i'm also kinda kicking myself for not applying for the FLAS (Foreign Language Area Studies) grant, which is less competitive and just for University of Michigan grad students. At the time, i didn't have my stuff together and wasn't sure if i would be able to commit to taking Thai for the whole year. it's ok though, life goes on. and i have to say, i super love my life overall. going through this process has really made me appreciate my family and friends (and googlechat). just like i said in my answer to what i want to be known for when i die, im really honored to be respected and loved and (maybe even looked up to) by all my friends - all of whom inspire me as well.

my friend sarah and i were talking about her rank list the other day, and about soros, and about academic elitism and how that impacts our lives and our choices. i am proud of myself for making the choice to stay at michigan and i am proud of my friends who make the choice to do what is best for them (in their lives) over what would generally be seen as "the best" by society, or your family, or your department chair, or whoever.

finally, i am so grateful for all the love and positive feedback i've been given over the past few weeks. this is from anjali last night: "whatever rhodes scholar. whatever robert wood johnson clinical scholars. whatever whatever. seriously. you're the shit and you've gotta keep believing in yourself. half the people who do these scholar things are really doing it for themselves and don't have a bigger vision in mind you're going to go SO far, and be respected by the people." sometimes i worry about how much of it i am doing for myself, and recognizing that even though that is a part of it (and that's ok), i definitely do not do the work that i do just to be congratulated on by someone else. i do it because i care, because im a woman of color, because life isn't fair, and because i have so much privilege it would be ridiculous and almost criminal not to do the work when people half as privileged as i am are fighting and struggling every single day.

thanks to all of you who do the work that you do. i am honored to be part of the movement.

back at it

hi everyone! i know i haven't written in forever, but im trying to get back on the blogging bandwagon. life (as always) has been crazy, and i've had my share of ups and downs over the past few months. a quick update of what i've been up to:

1) Starting my MPP (Master in Public Policy) at the Gerald R. Ford School of Public Policy at U of M. This semester has totally flown by already and I'm about halfway through the Winter term. Going back to my nerdy Swarthmore ways, I decided to max out my credit limit and take six classes (a regular full-time load is four). If any of you are wondering, my classes include:

Statistics
Public Management (The Politics of Bureaucracy)
Political Environment of Policymaking (focusing on science/technology policy)
Research Seminar on Science, Technology, and Public Policy
Health Care Reform (taught by Matt Davis, my advisor (also MD/MPP) and
Health Economics and Public Policy

I've been enjoying myself so far and keeping myself busy writing papers ranging in topics from why the CIA and FBI counterterrorism efforts failed before 9/11 & how their cultures reflect failures in public management (national intelligence is really siloed and interesting, actually) to an economic policy review of President Bush's proposed tax code reform to take away the favorable tax treatment of employer-based insurance and instead give all insured people standard tax deductions. Besides the academic part of it, I've started to make some friends who are also in my policy school classes. The fun thing about it is a lot of people are doing dual degrees in the policy school, so there's students from all different departments participating in discussions and things.

The Ford School admin overall has been super nice and supportive as well. I've been surprised at the lack of political advocacy that goes on in the student body (although I may be out of touch with what goes on after class). Being so heavily involved with AMSA and trying to include advocacy and activism in my daily life, I am kinda shocked that most people in policy school seem to be like most people in med school (although the policy people are more liberal overall). What I mean by that comment is that I feel that most people aren't making calls to their legislators, or paying attention to action alerts, or coordinating call-ins. To my knowledge, there has been no political action at the Ford School this semester and the student groups overall don't seem very politicized, but I do admit to having a limited knowledge of what is going on. If anyone wants to share other knowledge with me, I'm totally all about it. I also might try to shake things up once I get more situated ;)

2) AMSA

My life would not be complete without mentioning AMSA, of course. In the past few months, I've spoken at the first-ever premed Global Health Leadership Institute (amazing job organizing Courtney!), helped get together folks to lobby around PEPFAR (the President's Emergency Plan for AIDS Relief) reauthorization, and participated in the first-round interviews for the new AMSA Executive Director/ CEO (who was just named yesterday - yay!). I've been inspired by my colleagues, energized about the work, and happy to be a part of the movement. Some highlights of being down in Reston include:

-Thai dinner with Dr. Bill Kessler, former AMSA pres who formerly worked for the CDC and now is at the Center for Medicare and Medicaid Services in New England. We had a good chat about Thai food in general, my career, and how CMS and others decide what measures to focus on in pay-for-performance schemes. It was also great to be on an interview panel with some former AMSA presidents (who now serve on the AMSA Foundation Board) and see how they interviewed candidates and what they picked up (and didn't) in our group interviews.

-Watching the Super Bowl with Paige, Josh, Dawn (intern from Penn State and Sural's classmate), Adrian, and another intern (doh, I forgot her name). Yay Giants!

-Minerva (best Indian food ever!) with Dan Murphy

-Waking up at 3 AM to see drunk Paul Davis and Kaytee outside my door getting ready for Premed GHLI lobby day on PEPFAR reauthorization!

-Meeting new people and getting pumped about the future of AMSA!

3) 2008 New Year's Resolutions

So back in December, I was feeling kinda down about myself and about studying in general. I was unhappy about the 40+ pounds I've put on in the past three years, and I wanted to do something about it. I also realized that it was going to be tough to make major lifestyle changes if Chris wasn't on board....so I basically dragged him along with me and signed us up for a 16-week package at Fitness Together (FT) , this personal trainer place that's about a 2 minute walk from our house. Although he wasn't so gungho about it, he knew I was really unhappy and made the commitment with me to lose weight, get in shape, and stop eating such a crappy diet (we basically ate out everyday for dinner, and sometimes for lunch as well). Although this has been one of my New Year's resolutions before, I really wanted to keep it this time, and throwing down a bunch of $$ and making appointments/commitments seemed like it would get our butts in gear. You know what? It totally has!!

Basically, since Jan 2nd, we've been going to FT three times a week for 45-minute strength training sessions with personal trainers (aka getting our asses kicked). The first couple times were really painful, but it's been getting a lot better and both Chris and I have gotten a lot stronger even in the past six weeks. In addition to the strength training sessions, we're responsible for doing cardio at least three times a week. We bought a treadmill and have been running since mid-January (I totally prefer the elliptical, but running is the best!)

We've also been keeping these "accountability food journals" where we write what we eat everyday and then have our trainers review it once a week. We've been using a lot of recipes from the Eating for Life book and follow a diet where we eat every 2-3 hrs (so 5-6 times a day) and make sure every meal we eat contains a carb and a protein. The point of it is to maintain blood sugar levels throughout the day so you don't go starving yourself and then totally overeating when you get super hungry. We keep the diet six days a week and then get a "free day" where we can eat whatever we want. So far, it's been going really well, and Chris & I spend a lot of our time cooking together instead of going out. We also feel really good about ourselves and it's fun to keep each other in check! I am totally proud of Chris for *finally* cutting pop out of his diet as well.

4) Getting on good terms with the in-laws

Yay! Even without taking any classes on negotiation and/or conflict resolution, I was successfully able to negotiate a weeklong 'vacation' with my in-laws in LA. Bonding activities included playing with my niece Melanie (im actually not that bad with kids!), eating lots of Chinese food in Monterey Park, and spending a weekend in Las Vegas at the Wynn Hotel with Chris's parents. While in LA, I also got to visit AMSA friends & previous JRF's Anjali Taneja & Casey Kirkhart, drink lots of bubble tea at Lollicup, go shopping with Chris, and actually have LA grow a little bit on me. Perhaps the West Coast may be in our future...

getting my life back...in order

i don't like disorder (but mostly in a larger, life-picture sense). my room is always messy, i tend to make piles, and i often enlist the help of chris to find (or remember) where i've placed various objects. however, there is always a grand plan in the works.

over the past few months, my grand plan was derailed a bit. everything was on track until i didn't do so hot on a standardized test. this caused me to rethink the life plan for the year and decide to:

1) Not graduate from med school this year and
2) Not match until 2009.

because of this decision, i had to figure out something to do for 1.5 years. as i had always been toying around with the idea of getting another degree, i decided to jump in and explore my options. again, there were many options:

1) Master in Public Policy (MPP) at Michigan's Ford School of Public Policy
2) MPH at Harvard's School of Public Health (SPH), Johns Hopkins SPH, or UM SPH
3) Apply for another fellowship like Doris Duke to go abroad for a year
4) Work!

this was a really tough decision for me but on the advice of some mentors, i decided to stay at michigan since it was the only place i could get my MPP in the time frame i had. the MPP requires three semesters (rather than two) and gave me more opportunities to explore and be exposed to topics i haven't covered before (like economics and health care financing). don't be fooled into thinking this was purely a career-based move, however. in fact, this decision was one of the hardest decisions i've made because it was one of the first major decisions where i actually took something else besides my educational/career goals into account.

growing up, i always thought my education and career would come first. i was confident my family would support me and didn't think too much about where my partner at the time would fit in. usually he would come along or be supportive and if he wasn't, i wouldn't let that get in the way. working against my love life, i left home, went to swarthmore, then china, then thailand. boys would never hold me back.

it looked as if a wedding wouldn't stop me. i was gone for months in geneva and then bethesda leading up to my own wedding in michigan. chris was truly committed, buying a printer and sending out all our wedding invitations (he even kept track of RSVP's!) the day after we got back from our honeymoon, i got on a flight to thailand to start my fogarty year.

even though thailand was a second home to me, chiang mai was new territory. the id fellow (poo) and her fiancee at the time (p'nui, now her husband!) took me under their wing and i definitely love them for it. it was weird to be alone. i missed chris a ton and wanted him to share in the experiences i was having in thailand. a few months later, he quit his job and came to live with me. everyone thought it was crazy, but we had a wonderful time overall. and chris got a new job when he got back!

when all this decision-making was happening, chris was completely supportive. he wanted me to make the decision that was best for my career. my parents were gung-ho about harvard. as asians, they passed along their love for name-brand education + prestige to me. i don't like to admit it, but there is a part of me that does buy into academic elitist thought. even if it wasn't the best program or the program that met my needs the best, i couldn't dispute the importance and the wealth of connections to be had there. friends offered to talk to people. i was paralyzed by the choice i needed to make.

in the end, i only applied to the Ford School. i convinced myself that i wanted the MPP degree, and this was the place i was going to be able to do it. i'm the first MD/MPP candidate here and am excited about it. people have been incredibly supportive at the Ford School, which is a nice change from some of the challenges i've had to deal with from the med school side of things.

honestly though, what it really came to down to was putting my family first. staying at michigan meant staying with chris and being able to see my parents every weekend. even though chris volunteered to fly to boston or baltimore or wherever i ended up for the year and my parents totally thought i should do it, i knew it wouldn't be good for us. and it wouldn't be good for me.

even though i do feel like i'm mostly an independent woman, i am really much happier when i'm with chris. this was really highlighted to me when both an american friend and a thai friend noted the difference in how i was as a person before and after chris came to thailand. was this a sign of weakness? i used to think so, but not so much anymore.

a high-ranking indian doc in the UN came to speak to a group of med students a few months ago. i asked her how she balanced her career and her family. her answer was:

"i've always told my husband: children first, career second, husband third." she smiled. i laughed, and said i would tell my husband that, but it made me sad. i know i couldn't do the things i do without chris's support. sure, he wasn't who i envisioned i would necessarily end up with - he wasn't an activist, or an intellectual. he WAS a fraternity leader and he was actually pretty conservative. over time, he's definitely come around (no more shopping at Wal-Mart for starters!) and he helps me do the work i do. most importantly, he's never made me choose (or feel like i had to choose) between our relationship and the time i sometimes over-commit to education, activism, or service.

in the end, who are you without the relationships you have with people? i am eternally grateful for the relationships i have with my family and my friends. i'm pretty confident i'll continue to have a productive career, but i don't want it to be at the expense of who i am.

i've had this discussion with a lot of close girlfriends over the past few months who are making similar decisions about residency, or whatever next stage they're moving to in their lives, and i think we're all moving in this direction, recognizing that there are different things that can make you happy and feel fulfilled. most importantly, it's not copping out to make decisions based on these things, even if it's not found on your CV or something that's going to go on any application. more than ever, i've come to realize that mental health and overall life satisfaction/happiness is way more about the intangible things (like friendship) than i used to ever want to give them credit for.

maybe it's taken me awhile to realize this (as i strive to be an overachiever), but it's becoming easier everyday that i continue to work on it. thanks to everyone who's been so supportive! :)

two sad things, one happy thing

i have a few unfinished blog posts rolling around, but i wanted to take a little time out to share these three things.

first, the sad things:

1) after an elderly family member of a patient i saw in clinic found out i was interested in health policy, he proceeded to share his views on health care with me. the highlight of this conversation was (and i QUOTE)

Man: "I don't believe anyone dies from lack of health care."
Tanya: "Really? That's an interesting thought."
Man: "Yes. Everyone can afford insurance but they choose not to buy it. Who can't afford their medications?"
Tanya: "Well, I see lots of people who can't afford their medications."

Conversation ends when the actual patient returns to the room from a bathroom break.

2) two other med students (and myself) attended an evening session called 'Malaria Boot Camp' hosted by Nothing But Nets, a campaign co-sponsored by the UN Foundation and inspired by a campaign started by Rick Reilly, a columnist who writes for Sports Illustrated. His 800 word column asking people to donate $ for nets raised hella money from a segment of the population (men) that were largely previously inactive in global health. At the malaria boot camp, a famous scientist from MSU spoke about how he helped develop a new long-acting insecticide treated net with the private sector. this was cool because the net didn't need to be retreated & lasted for about 5 years, among other things. In the Q&A session, i asked a question (surprise, surprise).

Tanya: 'Dr. Wilson, you've dedicated your career to trying to help those who suffer from malaria around the world. My name is Tanya and I'm here with a group of students from Universities Allied for Essential Medications. Have you considered humanitarian licensing or have you taken other steps to ensure that the fruits of your research will be available to those who need them most?"

Dr. Wilson: 'I really don't have control over anything because it's completely funded by the private sector. I hope our net is brought to market, but that's not my choice.'

Tanya: 'Do you retain any control over the patents or intellectual property used for the invention of the net?'

Dr. Wilson: 'Unfortunately not; the company retains all the rights."

Dr. who is running the whole panel and is the Director of Global Health: 'Excuse me. Public health people like Dr. Wilson who are dedicated to researching issues like malaria do not concern themselves with marketing. We are out there to try to help people, not market things." He says this kinda huffily and turns around nodding to the other panelists like they should back him up.

I was totally offended! As a leader in public health, how can he say that marketing is totally not relevant? An analogy to medicine would be that we only care about treating our own individual patients and improving their health but don't care at all about the health systems we work in. After I told this story to my brother, he even said, "What's the point in inventing an awesome net if it's never distributed to the people who will actually benefit from it?"

Frustrating.

Happy things:

Thiru nominated me for 'Most Likely to Make a Difference' on Facebook. Small, i know, but it totally made my day.

Patients also make my day a lot in clinic. Sometimes I know it's ridiculous to gain so much ego boost from little comments people make, but it seriously does go a long way. Some of my faves from this month:

"She is the best med student in the whole med school!" - from a professor to a patient after she offered me a position in her husband's cardiology practice.

"Hey doc, she's really good." My attending looks around, confused. The patient points to me. "She knows how to explain things so that I can understand!" Attending: "Oh, she has to be good. She's a Michigan medical student." (Thanks, Doc)

"You better be here when I come back! I only want to see you." Sorry, I'm rotating off - and I'm just a med student.

even when i don't know the answers to questions when i'm getting pimped, i know that i'm good with - and take good care of - patients. clinic is also a lot more fun than i thought (props to all you people in primary care!)

things that have made me smile recently (and boy, there have been a bunch!)

trying to get back into blogging and realizing part of the beauty of it is that i can just write little tidbits of things rather than drawing out some large parallels between my life and the great truths of the world...er, you know what i mean.

it's 7:30 am. i'm starting outpatient cards today after being out of the hospital for a month. should be a nice switch from the MICU, but not such a sweet change from 'vacation' (ie studying and doing AMSA stuff like crazy month). since there's not much time, im making a list and going back to the topic of my blog - things that have made me smile recently. these are in no particular order.

1) i always thought i wasn't really good with kids, but decided to volunteer as a 'big sister'/'mentor' for this adopted asian girl anyway as part of a pilot program called GIFT (Growing in Friendship Together). most of the mentors are college kids that are also adopted, and all the mentees are Asian girls who have been adopted. we have group activities about once a month and then we also meet with our mentees separately. last month was the first month where both me and my mentee were able to join the group activity, where i met the other girls.

a month later, i emailed one of the moms who was helping out with this month's event (the Moon Festival, or zhong qiu jie, held last Friday night) for directions. she emailed me and said:

Hi Tanya,I've attached the flyer. Also--funny thing. K. just got a stuffed leopard and she named it Tanya. I asked her why Tanya and she said "Mom, you know--Tanya like the cool woman from mentoring?" She is such a watcher, she's clearly checking out all the mentors even while hanging out with her own.

That totally made my day! I was kinda feeling out of place before since I was one of the oldest mentors, but it's cool how something little like that can definitely make you feel like you're doing something right. later, at the Moon Festival, each pair of girls had to make a poster with pics and tidbits of what we liked doing together, what we learned about each other, etc. my mentee wrote (verbatim) 'I like evrything about Tanya!'. yay mentoring (and being a role model) for other young girls!

2) Finishing Cecil's. Yep, I read all 1100+ pages of the 'Essentials' version. I think I'll try to skim again, but it was not bad after you got into the groove of it.

3) AMSA family. Ah, AMSA is like a drug...gives you the high, but then you can never escape it. I spent a long weekend at AC Exec/GHLI and I totally got sick afterwards from not sleeping enough and being in intense meetings for a ridiculous number of hours each day, but it was really amazing. A shortlist of things that made me smile (will continue later since Chris is dropping me off at the hospital in five mins):

-getting lost in Dan's truck on the way to the retreat center with CJ and Dan Murphy. Fresh baked goods from Mom's Apple Pie Bakery. Trying to squeeze in and still drink our morning coffee.
-im'g/googlechatting with dan and vishad during the super long meeting
-late-night conversation and franzia sangria (with sliced apples) courtesy of julia
-encouraging people to listen to their hearts. kicking certain people out after it was way too late.
-writing my own global health vision statement.
-driving and walking with flavio for lobby day in DC
-late night talks, leftover chinese food, and capoeira performances at the AMSA townhouse
-having some really short (but valuable) quality time with rishi in the 10 mins we overlapped at ghli
-eating a homemade meal prepared by a lot of the male partners at ac exec - so nice to get out of meetings and have yummilicious food waiting for you
-teamwork (on a huge number of levels)
-watching 'the office' parodies done by med students about small group

ok, gotta run. more to come soon! it feels really good to blog again :)

continued from cards clinic (where I was actually sent on an unofficial consult to the hospital with the other med student on service..):

i'll continue on AMSA later. but, other things:

4) liz's eval of me (see 'comments' under previous blog entry). i dunno why, but evals like that make me feel so good about myself! am i a nerd? yeah, totally. do i like it? yeah, a lot :)

5) meeting up with suhani for sushi at DTW. i am starting to really get into airport dates. my first was with dan a few months ago at Dulles, where we had dinner and chatted, and this was my second official one with suhani. i havent seen her since she moved out to madison, and it was awesome to catch up, get some hugs, and to just spend some time with an old friend.

6) spending time with sup and karlo (two Ford School of Public Policy grads and APA caucus peeps) in dc, and grabbing dinner with davekumar. i was in dc a few weekends ago for this hiv psychiatry training and the american psychiatric association fall components meeting. the training was pretty good, but the highlights were definitely hanging out in a hotel room at jw marriott downtown, going to the adams morgan street festival with karlo and sup, visiting them in their place near dupont circle, and eating dinner with dave. i also met some cool people who are into global psych and caught up with roxanne, who was a global health fellow in geneva.

7) seeing patients again. a friend questioned if i was still into clinical medicine, and i have to say, i am! i saw a consult today in the hospital and really enjoyed looking up the history, taking notes, and talking with the patient. although im taking a year off, a mentor told me that i should try to keep my clinical skills as intact as possible, and i think i'm going to try to work with docs i respect in clinic if i stay here on my year off (which im really leaning towards doing).

8) family time! i see my parents almost every wknd if i'm around. they've been super supportive and really never fail to put a smile on my face, especially when we're ragging on my dad for being his silly self.

unchecking some boxes and shaking things up

so i haven't blogged in a long time. i have been busy, but i've also been thinking a lot about where i am and where i'm going down this pathway of life. i've been reflecting on failure, on what that means to me, on what has to be different the next time around. thanks to all of you who listened to me in call rooms, on the phone, in your living room, or over instant messenger. im always impressed by how forgiving and supportive friends and family are when im confronted with their reactions and compare them to my own.

it's interesting how failure can overshadow all the other successes in your life. it's irrational, but it's the way many of us, especially in med school culture, are programmed to work, our self-worth tied not to how well we take care of patients or our relationships with others, but on evaluations, standardized test scores, grades. i try to remind myself to judge myself by other criteria too, but no one is giving me an end-of-the-month evaluation on what kind of leader, friend, wife, or daughter i am. i don't get graded on what i contribute to the community, the number of emails i send, or how i love. one thing ive definitely realized through my most recent setback is that i love my life and i love the communities i live and work in. ive also become a lot more comfortable talking about failure and not being embarassed about it. indeed, i think that admitting to failure and dealing with it (both privately and publicly) is one of the hardest things i've had to do.

when i found out that i failed, i felt as if i had taken a majorly wrong turn in the maze of life and i wasn't sure if i was going to be able to recover, to advance to the next level (power up!) or to put a band-aid over my damaged self-worth. luckily, my go-get-em personality and overwhelming desire to make to-do lists took over. is it painful to know that some boxes you checked off with a flourish must now be unchecked? yes. however, is it fun to make a whole new series of boxes and schedules with different permutations because you suddenly have a lot more time than you had originally anticipated before graduating? TOTALLY. yes, i am a nerd, and yes, i do think that it is super awesome.

since im not graduating for a whole another year (spring 2009), i am applying to a series of dual degree programs. right now, im pushing to try and do a MPP (master's in public policy) over an MPH (master's in public health), but will be happy to also do an MPH with a concentration in health mgt and policy. i had originally thought to pursue these degrees sometime during residency/fellowship, but am super excited about doing them now. yesterday, i went to an information session at the Ford School of Public Policy (here at UMich) about the Science, Technology, and Public Policy graduate certificate and became totally pumped about being a graduate (and not professional) student. more on this to come!

to-do lists

ive always had an affinity for to-do lists. i think this started in high school, or even before, when i felt like i had a lot to juggle and needed lists to keep it all straight. my mother is primarily responsible for my obsession with multitasking, as she thought it was important to sign me up for every extracurricular activity available in a 1-hr radius of our little island hometown. if you dont believe me, here is a list of all the activities i participated in as a youngster: taekwondo, ballet, tennis, piano, art, writing, swimming, soccer, t-ball, basketball, community service clubs, tutoring, buddhist school....ah, the list goes on. ever wonder why im so involved (or obsessed with instant messaging while im on the computer)? ask my mom. even as a now-married pseudo-grown-up, ive taken multi-tasking to a whole different level.

i think this multi-tasking will serve me well as an intern, where my life will be filled by to-do lists, check boxes, and (somewhat) predefined tasks. in the past couple weeks, i have felt satisfied at checking off many (large) boxes centered around finishing up requirements for 4th year, applying for internal medicine residencies, and living life. presented in classic sign-out form, here are the highlights for you below:

Work:
[X] Step 2 (my last test of M4 year!)
[X] ERAS (Electronic Residency Application)
[X] Letters of recommendation for ERAS x 2
[X] Dean's letter appt and review (this letter sums up how you did in med school & talks about how cool you are)
[X] Internal medicine appt with Dr. Grum (for the Department letter, since i'm applying in medicine)
[X] CCMU (Critical Care Medicine Unit, or the MICU) - 2 calls down, 5 calls to go. I guess I really shouldn't really check off this box, but it feels good anyway, so I will, for right now.


Play (mostly):
[X] Celebrated our one year anniversary in Western Michigan. Chris and I stayed at a local B&B, ate some good food, and went shopping in Holland. We also got fabulous peach pie from Crane's Pie Pantry in Fennville.
[X] AMSA COC (Chapter Officers Conference). Lots of QT here with my some of my fave AMSA peeps, including Catherine Jones, Dan Murphy, Andrea Knittel, and Rishi Rattan. I also got to visit with Jay Bhatt.
[X] Hanging out with some fellow M5's, M3's, interns, and residents. It's been awesome to meet new people at different levels in the hospital and hang out with them on the outside. (I'm not sure Chris is as thrilled about this new development, but he humors me anyway. I appreciate it!)

Random fun stuff:

[X] I was found by Cooper, an organizer at Blogher, online. She contacted me about BlogHers Act!, an initiative you can read more about here. Women bloggers from all over voted on global health as an issue they want to tackle this year, and cooper asked me to speak at the unveiling of this way exciting topic. Unfortunately, it was the weekend before Step 2, so I couldn't, but I wrote a letter that she read to the assembled bloghers at their national conference. Fun!

[X] Kevin, a former GHAC chair, nominated me to be profiled at this upcoming exhibit at the Ntl Library of Medicine on leaders in global health. I'm still filling out written interview questions for this thing, but I did a phone interview where I talked about AMSA, Thailand stuff, and organizing. The exhibit goes up next spring/summer and will also have an online component. Hopefully, I can convince other people to get involved. It's also humbling (and heartwarming) to have people you work with respect what you do (and think about you when things like this come up.)

Enough signout for now. I've been a slacker about updating, and it's hard to get back into the groove of blogging, so I thought I'd start with what I do best - a checklist. All you intern readers out there - hope you enjoyed :)

NB- For all you non-med people out there, 'sign out' is something you have to do when you leave the hospital everyday if you're on an inpatient service. This consists of a blurb on your patient(s), why they came in, what you've done for them in the hospital, and then a list with little boxes (as above) for things you need your cross-covering intern (the intern on call) to do while you're gone. This usually consists of checking labs or following up on (specialty service) consults you have put in on your patient for a specific problem they might have. It also has fun tidbits on how to handle certain situations should the nurse call in the middle of the night. For example, one of my patients had this on her signout:

Note: Patient's BP falls to the 80's when she sleeps. If this happens and people are concerned, wake her up. Her BP will return to normal.

a day at the va spa

my attending went away for the weekend and so the chief of ID at the Ann Arbor VA covered for her yesterday. the chief of id is my kinda pseudo-advisor and i had some email conversations with her while i was still on my fogarty in Thailand and then later talked to her in person at the VA. she is hugely famous and is one of the world's most foremost experts on fungal and yeast infections. for medical people out there, let's just say that when i went to read about a patient i had with Candida parapsilosis, Dr. K. was the author of the Up-to-Date article "Overview of yeast infections." i was trying to explain how crazy that is to Chris, to have your attending be the primary author on numerous Up-To-Date articles in the field that you're hopefully going to go into. anyway, she's a big deal, but really down-to-earth and into teaching and giving good advice. basically, she would be a woman version of a nice dr. cox (on scrubs) but dr. kelso's age. i just got the feeling that that was a terrible analogy, but im free-writing, so i'm going to keep it anyway.

in any case, yesterday was pretty slow. i got one consult for a patient who had Bacteroides fragilis growing out of his blood cultures but E. coli in his urine, and we were asked about the source of his infection and on recommendations for treatment. i learned a lot with my senior resident (who was also interested) and hopefully made a good impression. i was surprised that i i didnt feel as intimidated as i thought i would and also was psyched to learn a few things on rounds, which always includes a trip to the microbiology lab, where i smelled some S. mutans on a plate. There was a vote on whether the S.mutans smelled like butterscotch or butter popcorn and I voted for popcorn (it ended up being a tie). who knew micro lab could be so fun?

later, we went to change a dressing on a wound. i went to help get supplies and had tape to keep the dressing in place (which i can never tear). dr. k. watched me struggle with the tape briefly and then took it from me and ripped a piece off without a problem. her advice to me: "you have to be bold!" the patient's wife (who was learning how to do the dressing) interjected that she always had a problem with the sticky tape so i didn't feel so bad. granted, i still am decades younger than either party though. note to self: practice tape-ripping skills for further ID work.

after rounds, i went to work on my note. during that time, i got excited since i received an email from an administrator at Johns Hopkins saying that the Fogarty International Center funds from their center would pay for me to go back and spend a month at Dr. Cynthia's clinic in Mae Sot, on the Thai-Burmese border. this means that i will return to Thailand twice this year, once as a OC Hubert/CDC Foundation scholar and once with Fogarty. I'll be spending about a month in Thailand each time and be based in two different places (Nonthaburi, outside Bangkok, for the CDC, and Mae Sot/Chiang Mai for the Fogarty). Maybe fourth year will turn out to be more like my "year off" than I originally thought. :)

in any case, this email got me really excited. when i went to leave for the day, i stopped by Dr. K's office and told her about it and the projects i was going to be working on in thailand. we talked about how medical education was changing at michigan (some medico-legal officer doesnt think student notes should be allowed in the medical record anymore?!) & the differences between thailand and the us. i brought up that the Fogarty Center had solicited a piece about "the need for patient education and health literacy in the health care system, drawing from your experiences in Northern Thailand" after reading my article in The New Physician. i was kinda offended although i'm not totally sure why, but i feel defensive about people just being like "can you comment on the plight of the poor?" or the sentiment of "please draw from your exotic experience and perspective as a first-world person working in the third world." it's not like people in the US don't need health literacy too, although i don't think the woman who emailed me was implying that they didn't.

i ended up writing the article, which i posted on my friend's health-care related blog, cure this!. it will also be published in the July issue of Global Health Matters (the Fogarty newsletter), but decided to compare my experiences in the US and Thai health care systems instead of just focusing on Thailand's shortcomings. Dr. K. and I talked about this for awhile, and i was really struck by a comment she made when I noted that my close friend (and ID fellow) would see a ton of patients in clinic and not really have a ton of time to talk to them or write the best ever notes in the chart, but she was still providing good medical care. Dr. K corrected me - "excellent medical care" and noted that Thailand's health care system may not be perfect, but the docs over there were truly saving lives.

as i prepared to leave, she said that she was excited for me to return to Thailand and advised me to take malaria prophylaxis, adding, "You should go back - it's a privilege to be in a place where you can really practice medicine."

i sometimes wonder if mentors know how much students look up to them, and how a little comment can really go a long way.

i am an immigrant in a country of immigrants

i started id consults today. besides myself, my team consists of another 4th year med student who was originally in my class, a third-year in her last month of internal medicine residency, a fellow from Romania, and the attending. dr kauffman introduced me to my attending (dr malani) last month and i met with her to talk about possible research projects a few weeks ago. besides having a common interest in id, we also discovered that i lived in the house across the street from her childhood home until i was eight years old. the world is small, and the island i grew up on is even smaller. in any case, we decided that i was going to work on writing a review of HIV care in the elderly patient with her and another fellow & plan on publishing it in a geriatric journal. im super excited about it and think ill learn a lot! yay for side projects :)

back to id consults and my team. i think the first couple days on a team are always interesting because you're getting to know people because you're sitting in small rooms with them. of course you're talking about patients part of the time, but (if you have social skills) you're probably talking about life-outside-the-hospital for most of the other time while writing notes, waiting for phone calls, or just doing busy work. as a team of almost all women, the subject of families (and children) inevitably came up early on. all of us are married except the guy on my team, so we talked about husbands and husband's jobs and whatnot. i also found out that my resident went to a liberal arts college and did post-bac at bryn mawr (yay tri-co). she noted that she thought we (as michigan med students) had to work way harder (and learned more) than she did during med school but that it probably didnt matter in the long run. i told this to post-call liz today and she confirmed the widely-believed rumor that michigan med does totally prepare you for internship, so at least i know the q4 is worth it :).

in the afternoon, i got a chance to bond with the fellow who just started at u of m last week. she is originally from romania, where she completed medical school and trained in id. she admitted she was nervous about starting (arent we all, regardless of what stage of training we find ourselves at at any moment in time). we talked about our backgrounds. she talked about moving to america six years ago when her father was approved for a green card and the decision on whether to leave her career and her husband's career (as well as their homeland and life) behind. in the end, they decided to try it for their children who were six and two at the time. she vividly remembers taking her son to first grade in october, when they arrived in america. he did not speak a word of english, and the first day of school he asked his mom "what should i do if i have to go to the bathroom?" talk about resourcefulness and resilience. when she told this story, she was proud of him and proud of his struggles. they all struggled at the beginning, working jobs that paid less than $8 an hr - a big change from their professional lives back at home. eventually, she started studying, got into a residency, and matched into id at u of m. her eyes lit up when she talked about it, saying that she suffered from a lot of inferiority issues as a international medical graduate, didn't think she would get in to an IM residency in the US, much less fellowship. getting into michigan was a "cherry on the top", in her own words. i felt privileged to hear her story and to work with her. it reminded me of how lucky i am to be educated in this country and of the opportunities i have. she also gave me the opportunity to share my story with her.

i am second generation thai-american. i am the daughter of immigrants. i grew up in an almost exclusively white neighborhood on an island and was one of two or three asians in my graduating class.

i wanted to be white for a long time (i didn't really talk about this part with my fellow though). i was frustrated that my parents had rules that my friends didn't, like family dinner everyday with no tv and talking about everyone's lives. i had the same curfew from 9th grade-12th grade until i threw a fit my senior year and got it extended to 1 am (but if i was out, i still had to call to check in). even now, as a married woman and almost-doctor, i still try to call my parents everyday.

identity was a hard thing for me to figure out and was definitely a learning and growing process throughout my young adult life. my parents were always supportive and adamant about being not-american (which they equated with being white). sometimes, it was okay to be american because it was good to blend in and win at their games (academic ones, of course). i distinctly remember my mom saying, 'if another kid in your class gets 95%, you have to do better than that because you are asian (and your work won't count as much).' she thought it was also important that we were able to succeed in an all-white environment since she figured that was what our workplace would look like in the future. interesting message, but one that stuck with me for a long time - fit in, but remember, we are not like them.

i spent a lot of my adolescence fighting with my parents who were raising me 'thai' which meant no going out after darkness and no boyfriends (for girls). obviously i rebelled against all these rules, but i have to give it to my parents for trying. in retrospect, i can say it was okay to be raised 'thai' (and many thai people, including all the nurses i worked with at the repro health clinic in Chiang Mai, approved).

as an adult (it's weird that i am no longer considered to be in the 'youth' category, although 26 is the cusp), i am proud to be the daughter of immigrants. i think my parents demonstrated incredible strength and recognize their sacrifices to give us the lives that they didn't have. i think it is super awesome to come from two worlds, to be thai, to be asian, to be american. i feel like being the daughter of immigrants gives me an unique perspective on language, culture, and struggle. chris and i have talked about our children and how they will be third generation, and that i am sometimes sad that they will not be children of immigrants. i used to think that so much was lost from generation to generation, and sometimes i feel that is still true, but i think a lot is gained too. my parents wouldn't speak out or protest at a rally, but they do donate money to causes (like MSF, or Doctors Without Borders) that they think are cool. i do both, and i try to actively pursue social justice in my life and career (hopefully my kids do too!) with privilege comes a lot of power, and im trying my best to use my privilege to do good in the world. i think it's working so far :)

at my fellow said, 'i came here for my children - if they are ok, i will thank god and know that i made the right decision. i have no regrets." i said, "i think my parents feel the same way and i think your children will be good and make you proud." when i left, she said "thank you for sharing your experiences with me." i smiled and said, "thank YOU!" i think it is really brave for people to share their stories and be honest and admit to their insecurities with others, especially at the first meeting.

it was nice to have that conversation to set the tone for the month, and to remind myself that i do make my parents proud in both traditional (yay my kid is going to be a doctor and my life is complete!) and non-traditional (what is this social justice you're always talking about?) ways. i tried to re-enact this whole conversation with my mom tonight (in the middle of writing this blog entry) but she was watching a korean soap opera (i could hear the music in the background) so she didn't contribute much to the conversation. go figure.

US Social Forum and my identity politics

a good friend and past amsa pres was supposed to speak at the US Social Forum in Atlanta about access to essential meds and pharmfree but couldnt make it at the last minute. i was chosen to go in his stead. i didnt really have any background about the US Social Forum at all and tried to hurriedly make plans to get myself down there and find a place to stay. it was pretty stressful. my last-minute ticket cost almost $500 and none of my friends or contacts could offer me a place to stay. i ended up splitting a hotel room downtown with a college student my age from DePaul in Chicago whose class was centered around the US Social Forum. The trip overall cost over $800 for me, but i was able to use my savvy fundraising skills and get most of it covered through IPHU & Global REACH at Michigan. i am thankful for those who support students to attend conferences like these because they really give you a chance to ground yourself in what you're doing. at the same time, my experiences at the USSF really pushed me to go beyond my limits in thinking about not only my identity as a woman of color, but also about the politics that inform my work and my life.

it has been a long time since i've been to a non-health related - or even non-academic -conference. although amsa is awesome and has really helped me provide me with a community of like-minded peers throughout my medical school experience, i was reminded in not-so-subtle ways during the USSF that being a future physician made me part of an elite community. i was no longer a 'college student' or a 'community organizer.' i was not 'youth'. sometimes, i was a representative of the 'broken health care system' or 'the medical establishment.' comments on the first day of the IPHU (International People's Health University) brought back vivid memories of me not feeling XXXXX enough in college. Not Asian enough, not poor enough, not radical enough. i felt frustrated because i didn't like the way i was being judged. i am working hard in the best ways i know how to fight for health care and social justice. med school has not been an easy road for me, but sometimes i need to be reminded that my life has been one of extreme privilege. i struggled with that fact in college for a long time. feeling guilty and not knowing how legitimate i could be in fights for social justice. discounting my parents' struggles because i was angry and felt like i didnt have any of my own to share. growing up and realizing how insulting that was to my parents who worked around the clock to give me all of those things that they never even knew existed in rural Thailand. appreciating them for sending me to Swarthmore, where i began defining social justice for myself, and being okay with bearing their hopes and dreams while still trying to figure out the ways in which i wanted to infuse and live my own life, but not totally ready to believe that my life was partially theirs too.

i remember a conversation i had with a friend, rafael, in college. i was in my i-will-not-go-to-med-school and my-parents-cant-make-me stage of my pre-med career, and he was really adamant about me taking agency and doing what i wanted with my own life. "Screw your parents!" he said. "It's your own life; you're the one living it!" "What would your parents do if you didn't do what they wanted? Disown you?" i had never thought of things to that extreme but just knew that i really felt guilty disappointing my parents in any way. i also felt like i had a big responsibility to prove to them that everything they had done for me was worth it (my mom was never hard-pressed to compare our family to others to prove how committed she was to us). looking back on my childhood (and even at my life now), i have to give it to them though. i had every lesson - ballet, TaeKwonDo, ice skating, roller skating, swimming, piano, and more - that my mom thought would make me a well-rounded person. i went to summer school or camp as soon as i was old enough. my parents' lives were consumed by working at their family practice to save up money for lessons, for school, for medical school. their dreams were a big thing to carry. sometimes, i think they still are, but ive learned many things over the years that have made it a little easier.

i had dinner with a friend and family physician, anjali, where we shared stories of our second-generation histories, stories of how our parents had shaped our lives and stories of how they could be the most supportive people in the world or how they could crush the fragile (independent) identity you thought you had built for yourself. anjali asked if my parents had been supportive of my 'years off' (particularly this last one). i think so, i said, but i prepped them for a long time so they knew it was coming. i have learned to use their language and to frame my decisions in terms of things they value and understand. in college, my parents valued getting into medical school, and now, they value getting into residency. i frame almost everything i do into these contexts and they're okay with it. i've also had a decent track record so far, so i think they've learned to trust me (although they were a little shaky about the whole majoring-in-Chinese thing and organizing in Philadephia's Chinatown in college). i often talk about karma with my parents as well. good karma through my actions is good karma for my parents. to me, it also means that im using my privilege to try and make a difference while i have the chance to do so. i wake up everyday and think about how lucky i am. i hope that i am living up to my past lives and my past karma as well, and pouring water and not salt into the mix. (see analogy from a Buddhist monk in the entry.)

back to identity politics. after being totally overwhelmed by the number of workshops offered at the USSF (about a hundred for each time slot), i decided to center my didactic experience around asian-american issues, attending workshops set up by NAPAWF (National APA Women's Forum) and CAAAV (Coalition Against Anti-Asian Violence). i contributed to the IPHU and to conversations about health care access by presenting about what is going on with Thailand and Abbott, but did not go to any other health-focused workshops after that. i heard amazing presentations from groups like the Asian Pacific Environmental Network, the Bus Riders Union, DRUM (Desis Rising Up and Moving), the Chinese Progressive Alliance, and the API Women and Family Safety Center. i participated in discussions about trafficking, heard stories from workers in sweatshops, and was excited to see and be around tons of progressive APA youth. i felt the need to move to california to be a part of these movements, this organizing. i remembered what it felt like to be comfortable in a room where everyone looked like me. i realized that my days of asian-american organizing were not over, that it was silly to think that i had grown up and moved beyond identity politics because i had already figured out how to be proud of being Asian-American. i finally thought about immigration and diversity and about a lot of things that were coming down around me and how this connected to our struggle as a people and to many other struggles as well. i remembered the moments i had become excited about going to medical school when i saw that health care was a basic right that people needed and i thought that as a doctor (like Dr Siu in Philadelphia) i could provide that. not having health care came up over and over again when people were sharing their stories. all of this resonated with me, and a part of me came alive again.

throughout the four days i spent in Atlanta, i had long conversations with people i cared about and met some new friends as well. i thought about priorities, about what i want out of a residency program, about what kind of community i want to be a part of and how i could build that. i shared my perspectives and my stories and made commitments to help people process where they were going and what they were doing whenever i could. i was happy to come home and didn't feel guilty about it. i thought a lot about how i could be a part of the asian-american movement while being in the midwest. i thought about how, when one of the organizers of the workshop got people to stand up in groups and cheer when he called out where they were from, he didn't know to call out after saying "California" and "NYC" and how the Midwest and South and Northeast just all got lumped together. i briefly felt not Asian enough, but then thought about the necessity of representing my own community that was not based in LA or the Bay Area. i reminded myself not to be ashamed of being, as F.Omar Telan refers to himself as, suburban fabulous.

i briefly shared some of my thoughts with chris when i got home pretty late at night and tried (unsuccessfully) to re-enact the CAAAV workshop with all the different speakers sharing their stories in different Asian languages. before we went to bed, i told chris that i maybe wanted to move to california. he smiled.

june meeting

amsa june meeting has been a part of my life since M1 year. it's basically a big meeting where most everyone on national leadership (board of trustees and action committees) get together and plan the rest of the year. it's also a space to be inspired, rejuvenated, and to love and be loved for your work and your commitment to health justice. my amsa friends have definitely been some of my closest friends over the past four years and it's been great to have a national network/family behind you.

this is the first year i've been a chair (or project manager, as it's known in corporate america) on the action committee side of things. this means that i make sure work gets done among my five coordinators (all fab, of course!), offer support to them and others in national leadership throughout the year on issues of policy & programming, and represent GHAC at-large on the AC Executive Committee. it's a big job, and i'm happy to fill it, although i did waver back and forth on whether to run from abroad quite a bit. (thanks to chris for listening to me do this and continuing to bear the brunt of my vacillation on all things AMSA). overall, i LOVE AMSA and think it's really super awesome, but sometimes it's difficult to keep things in perspective while also being a fourth year med student, wife, daughter, and friend, among other things.

june meeting was AMAZING in a lot of ways. i finally got to meet my committee and run my first meeting as ghac chair. i think i did the best job i could, but know there's a lot of room for improvement, and really need to work on following-up with people to make sure deadlines get met. the best thing about committee time is that i think that our committee really bonded together and that we gained an appreciation for each other not just as friends, but also as activists. ghac continues to grow bigger and better as the years go on, and i'm very excited to be a part of the energy with a brand new group of coordinators as we start off another academic year. i feel like i have so much to learn from each person on my committee and that i'm very inspired and excited to support them in all their work this year. being a chair is also a great chance to reflect on my experiences within AMSA leadership, and i was reminded even more of this when i looked over my speech to run for chair, which i've cut and pasted below for those of you who weren't at national convention this past year:

Hi everyone! Thanks for coming to GHAC org time, whether it’s to run for a national position, support a friend that’s running, or just to check things out. I really appreciate all of you being here, especially since it’s near the end of conference, and you all must be exhausted from speakers, workshops, meeting new people, and hopefully, being inspired by fellow students and activists. I’m really sad that I can’t be there in person today (this is the first conference I haven’t been to since 2004!), but my thoughts are all with you from Chiang Mai, Thailand. If you haven’t noticed yet, being part of GHAC usually means you have friends to visit in cool places.

My name is Tanya Wansom and I attended my first national conference three years ago, ran for the HIV/AIDS coordinator position, and never looked back. I’ve been involved with GHAC for the past three years as a coordinator for two years and an editor for Global Pulse this past year. AMSA has given me a lot of opportunities to grow – as a leader, an activist, and a community organizer – and I’m excited at the prospect of running for GHAC Chair, where I can support the future generation of AMSA leadership using my past national experience and also make sure that the general membership keeps getting more involved.

As chair, my main duties are to support my coordinators, represent GHAC to the larger national AMSA leadership (including the president, Board of Trustees, and other AC committees), and make sure the general membership at large knows what’s going on and how to get involved. I’d like to bring back general GHAC monthly newsletters on the listserv and look into starting an AMSA GHAC blog where everyone can post articles on different topics and activities that are going on in different regions. Also, I’d focus on institutionalizing many of the liaison positions we have with other professional global health organizations (and expanding them) to make sure there were more opportunities for students to study, work, and find mentors abroad. Most importantly, I’m happy to hear about what you – as a GHAC member – would like to see GHAC working on or doing in the coming year.

GHAC has, and will continue to be, a powerhouse in AMSA. I hope you give me the opportunity, as chair, to build on the work that so many people have contributed to over the years. Thank you.

AMSA has definitely been one of the defining experiences of my medical school career. I'm especially happy to serve on AC Exec with many friends from over the years, including some of us who had taken a year off (Catherine Jones, Community & Public Health Chair & Vishad Sukul, Humanistic Med Chair). Michigan Med also has an amazingly strong presence this year on AC Exec with three members on the board (me, Michelle Debbink, HPAC Chair, and Andrea, LGBT CHair). Andrea and I had the opportunity to get to know each other *a lot* better after spending five hours waiting for a flight together, which ended up getting delayed to the next morning due to 1) a tornado and 2) a computer glitch that shut down everything on the East Coast. andrea and i also roomed together with Catherine and Laura (also on LGBT HAC) and affectionately named our room the 'lame-o' room as we are all not so into partying, drinking, and staying up really late (although we inevitably do anyway). we are into changing into our pajamas really early, trying to go to bed early, and waking up early to eat breakfast (hence the lame-o term).

anyway, besides being a lame-o at amsa meeting & riding the grandma bus home early after actually going out to washington, dc, i was really happy to meet new AMSA peeps and reconnect with old ones. i really like the group of people im working with on AC Exec this year and feel loved and supported by most of them. i also got to see some of my old fave peoples (albeit briefly) at June meeting including Casey (RT), Davekumar, and Kevin Burns. being back into the AMSA swing of things has helped me readjust to my life back in the US and given me a place to channel a lot of my energy and enthusiasm for the year. it's also been a source of some (good and bad) stress, namely in the forms of trying to set up basecamp (this online networking tool) for my committee and also as a last-minute invite to speak at the US Social Forum in Atlanta this coming up week. I'm totally honored to be asked to be one of the AMSA reps at the USSF, but it was really stressful to buy a ticket, find a hotel room at the last minute, etc. In any case, I'm excited to participate in the International People's Health University, a four-day short course on health justice and organizing, and to speak at an Access to Medicines panel at the conference itself. I will also be meeting up with fabulous AMSA peeps Dan Murphy (now the legislative affairs director), Anjali Taneja, Kevin Burns, and Catherine Jones. Hopefully I won't have as many problems getting to Atlanta as I did going to Philly & DC on earlier trips this month.

ups and downs

since my sub-i has ended and i've been on a 'vacation' month (meaning im not registered for any rotation at my school), i've felt like i've really run the gamut of emotions since i've actually had time to think about being back in the US, process a little about Thailand, and get used to my role(s) as daughter, medical student, sister, and friend again. nothing too extreme, though. my life has definitely been in a lot of flux lately - starting fourth year with a different class, sending many of my friends off to different areas of the country, and figuring out what my responsibilities are (and what i want them to be) regarding the million-and-one extracurricular activities that i have gotten myself into over the past four years. a lot of times these activities - especially AMSA - are the ones that have kept me sustained and focused throughout my medical school career, bu they can also be the source of stress, frustration, and the feeling that i've gotten myself into deep.

my year off was good to give me a sense of perspective. i didn't keep that perspective for too long though and jumped back into a VA sub-i, where i was kept busy for most of the hours of that one month rotation. when it ended, i realized i had a lot more free time (which was supposed to be used for Step 2 studying), but ended up being devoted to what i affectionately refer to as 'life maintenance' instead. don't get me wrong - im definitely studying for step 2 - but im also traveling A LOT (more than i would like). during the month of june, i will have been to Philadelphia, Washington, DC, and Atlanta, all on separate trips. more on each trip below:

1) Philadelphia. i attempted to go to my five-year college reunion at Swarthmore with Chris almost immediately after i got off last call at the va. our flight ended up being delayed a few hours due to weather on the East Coast and then cancelled altogether. chris got a flight attendant to schedule us on a direct flight for the next day (Saturday) arriving at 3 pm. i was exhausted and frustrated with the whole ordeal and really wanted to eat breakfast at one of our fave ann arbor spots, northside grill, the next morning. we ate there and then hustled to the airport to catch our flight. in the airport parking lot, i (finally) noticed that i had accidentally left my purse at the restaurant and did not have any id. we tried to call my brother to have him pick up the purse to no avail. chris was less-than-happy and tried to go talk to an agent about getting on another flight. i felt like maybe it wasnt meant to be and we shouldnt go at all.

the agent said i could fly without an id (you just had to go through secondary screening). i was stuck in secondary screening for awhile and had to run to the gate. i almost missed my flight to philadelphia (where i had been upgraded to first class). this whole incident reminded me of the first time i met chris (less the id part) since it involved running in an airport, chris arguing with a flight agent, and us sitting on opposite ends of the plane.

the swarthmore reunion was okay but i had missed 90% of the events for the weekend and we ended up not being in the philly area for very long - a little over 24 hours. a lot of my friends from swarthmore that i haven't seen since graduation also were not able to make it. however, i did get to hang out with some of my favorite people from tri-co, had a little reunion with people in medicine from my class, and spent some QT with bryan. highlights of the weekend included:

-just being on campus again and being super jealous of the new science center and wondering what happened to parrish (nice student lounge, though!)
-eating a huge bowl of pho for $4.95 at xe lua in philadelphia's chinatown
-breakfast at java joe's in woodlyn
-buying more swarthmore paraphernalia (chris even got a swarthmore t-shirt...the swat fever is taking over :) )
-meeting geoff semenuk, the associate director of alumni relations, who ive been chatting with online for the past month or so. he introduced me to some cool alum who are at the CDC that gave me interesting advice/perspectives about different ways to pursue public health careers.
-catching up with some of my old bio profs
-walking in the crum woods with chris
-a wawa sub and lemonade-iced tea
-king of prussia shopping spree

overall, a good weekend, but a little disappointing in terms of timing, not being able to see all my friends, and wishing i couldve spent more time in philadelphia.

next trip - AMSA june meeting, reston, va. (im doing this as a separate post because i think things will get wayyy too long).