And how could I forget...

As I said before, Mon culture goes back a long way but is fading. The people though are eager to promote it, and I saw some great t-shirts while in Sangkhla: "Make Monday Mon Day!" and "Wear Red on Monday!" Traditional Mon dress is red, and the red on the shirts had the same pattern as traditional Mon longyi and paso. I overheard a conversation in Burmese at my guesthouse and learned that most of the staff are Mon and speak Burmese. I'm finding Thai to be less and less useful.

We were talking about all the things that are really strange but that you start to overlook. One of those is the fact that Thai sweep their lawn. In all the parks there were people constantly sweeping leaves. Not much is left but dirt and the scratch marks left from their equivalent of a rake. Raking leaves at home is similar, but here leaves fall all year round and it seems much more pointless.

I've decided to skip Hellfire Pass museum and just lay around today. It's been nice. I'm eating lots of Western food and enjoying my first non-Thai bed (ie not hard as a rock) since I arrived. Tomorrow I'm off to Bangkok and then Phnom Penh. Also I've found that the Lonely Planet-type books are generally half-right. Generally, for every place listed in it there are three look-alikes near it that cost 30% less and are never full. Not quite sure how places make it in there, but it's a real benefit for business if they do.

New Year's!

I had a unique New Year's celebration, but I'll quickly describe how I got there. I took a long bus ride from Mae Sot to BKK at night on the 25th, then another few hours to Kanchanaburi. I met a friend there and we went to see the bridge over the river Kwai. We then took a bus to Erawan National park and set up camp.

Parks here have quite a lot of land, but it's not nearly as developed as at home. Each had just a few miles of trail despite the huge amounts of land. Erawan is somewhat well known. A creek comes down a valley with lots and lots of cascades, I think 7 of which are officially named. We finished u around noon and there was a regular bus from the park to take us back to Kanchanaburi.

From there we took the regular bus toward Sangkhlaburi and got off at Sai Yok Yai park. It was quite nice and relatively deserted. There were lots of small trails to little things like caves (where we saw bats) and bamboo forest where we saw some monkeys. There are some pretty waterfalls around 20 feet where two smaller creeks join the river from above.

Back at the highway we were quite lucky in catching a bus towards Sangkhla. We ran into trouble when we stopped in a small town and were put on a very slow bus full of kids going home from school. We still reached Khao Laem park, though a bit late. The food shop had closed, but some very welcoming people from BKK let us share their dinner. This was maybe Dec. 30, and there were part of a pilgrimage of people from BKK to Sangkhla, which made life easier for us in some ways. We did a hike there that was through fairly dense jungle which was fun. Then next day we walked 2 km down the road to the other camping area. It was beautiful, overlooking a lake surrounded by mountains. Not much to do there but sit and admire the view, but we were happy to do that.

Getting from there to Sangkhla was a bit difficult. We waited for maybe 4 hours for a bus that would stop, but we made it. This is a beautiful town. There is a Thai side and a Mon side. Mon are one of the oldest ethnic groups in Burma but have been on the decline. I think the language is derived from Pali and they brought Theraveda Buddhism to Burma. My traveling companion works for a Mon education group that has a house for students/teachers. I've been here for two days now and it's been good. The food is great -- I've found that it's not that I dislike Burmese food, but that the clinic's version are not so good. Maybe it's universally true about hosital food.

Anyway, New Year's was with a bunch of Mon people. There were party games and a gift exchange, the most popular gifts among all were large pink stuffed animals. We were up on a hill overlooking the city. The Thai were releasing lots of the krathongs, the floating lantern things and at midnight there were fireworks below. It was really pretty. Other than that, I've just been walking around Sangkhlaburi which has been nice. I'm glad my friend is able to give me such a good tour.

Today it's back to Kanchanaburi for two nights. Tomorrow I hope to get to the Hellfire Pass/Death Railway museum just north of town. On the third I have a 3:00pm flight to Cambodia. The trip from Kanchanaburi to the airport is probably less than 100 miles and I can start at 7am, but I'm still a bit nervous. Shouldn't have any problems getting to the airport on time.

One of my patients is famous!

I think I referred to here in an entry here earlier: a maybe 10 year old girl who came with her 2-3 year-old sister. Someone associated with the clinic wrote an article about them that was in a section of the Bangkok Post: http://www.bangkokpost.com/news/investigation/29651/for-choo-it-all-work-and-no-play

The picture is great. The little one's cheeks are puffy because she has nephrotic syndrome. They both always wore a lot of thanaka, the white stuff.

Here are a few sentences from Lloyd Jones' Mister Pip, a really good (and short!) book:

"In the tropics, night falls quickly. One moment you can see the dogs looking skinny and mangy. In the next they have turned into black shadows."

I like that in describing the tropics, mangy dogs are implicit. Yeah, you have to describe sunset and other things, but the dogs are just understood. Just like in the beginning there was god, in the tropics there are mangy dogs.

There is an article in The Guardian about CIA links to mid-eastern intelligence agencies that thinly veil (if that) there use of torture: http://www.guardian.co.uk/world/2009/dec/17/cia-palestinian-security-agents. It's something that I assumed happened, but it's different now that I work with people and have friends who have endured years of the same torture techniques mentioned in the article. One guy is a Burmese pediatrician who did several years and later came to the clinic to work. Two years ago I remember him being bit odd, now he's completely gone. In addition to simple irrational behavior, he's got all the hallmark signs: multiple layers of inappropriate clothing, always listening to a radio and often talking to it.

People who have spent a long time in Burmese prison all have similar traits -- they are trying to resume normal life but are uncomfortable most of the time, sometimes only relaxing in a closed room with just a few close friends. It's hard to work, they can never go back to burma.

I'm continuing to enjoy learning Burmese. I think that's been the one thing I've been most interested in and put the most effort into. It's fun day-to-day but of limited usefulness anywhere else, although I think I will compare the list of Burmese refugee resettlement sites in the US with the list of residencies I can apply to. A few programs might see it as a big plus. I don't like outpatient clinic, but Burmese refugees are ideal patients in many ways. I would gladly fill my schedule up with them, although they likely come with some serious psycho-social issues which I am not overly fond of.

My impressions so far

I'm three months in, and feels kind of like I'm halfway. I think I'll travel some in January and March which will make the latter part of my stay go more quickly.

I've enjoyed it so far. I'm starting to get used to life here. At first the challenges were with basic things like finding food, communicating with people, getting used to the clinic. Now I'm more comfortable with those things and my challenges are more work-related -- finding and organizing information, figuring out what to do with patients. It's more like work, but that's good. It's what I'm here for.

I may change my mind, but I'm starting to think that Mae Sot may be a bit posh for my tastes. Maybe if I came back I'd want to be further out. This is a good place to transition into this kind of work (lots of guidance, people around who speak English and the locals are used to foreigners), but I think I'd eventually like to work in places that are further from the aid-hubs. We'll see. Not this trip, but down the road...

And how could I forget...

One of the best parts of being here is feeding people. Imagine that you are surrounded by underweight people who make about $30 US/month. At home, how many people are you helping by giving a large pizza to? Very few. Around here, you are helping them out. A cheap pack of hair clips or a soccer ball can win many friends here.

And my Thai so far consists of food names, numbers, "it's not a big deal," "It's cool," and "It serves you right." That ensures that I can never contribute anything useful to a conversation (unless it involves eating/buying things) and almost always gets a laugh.

The lighter side of life here

It seems I often complain to friends about the difficulties here and thought I might take a minute to mention the fun things. It's generally the small things that make life more entertaining.

My apartment is run by a Thai couple but there are a few Burmese people who do all the maintenance and run a laundry service. The Thai woman is often not very nice to them. When I left this morning she was complaining to them about something, but in Thai so I didn't understand. A bit later (when she was gone,) I said in Burmese to them, "she's crazy isn't she?" The one who knows the least English (I thought none until this encountery) said "bloody fool," which she had to repeat a few times for me to understand it. Maybe all she knows besides "good morning."

I just had dinner with a few people, one of whom is a German physician who I suspect to be in his 70's. When he arrived, he brought a lot of medicine with him. At the airport the customs guys found out about it and detained him. They basically wanted a bribe, but he refused to give it, so he spent two days in jail for possible drug trafficking. When we asked what it was like, he said, it's just like any jail. We pushed further and it turns out he's been incarcerated a few times, noteably in Moscow in the 60's. They thought he was an American spy.

He lived in Malaysia fora while and took on several kids as psuedo-adoptees. One was desperate to leave and when he turned 18, they got married. Germany accepts gay marriage and so they went through a long process of convincing everyone that they were in love. A year later the kid got a German passport. When whatever time passed that they could get a divorce and his adopted son/spouse could keep his citizenship, the filed for divorce. During the hearing, the judge commented on how well they seemed to get along and, however strange the relationship might seem, maybe they should try to work things out. The Tamil kid is now happily married (to a woman) and quite successful.

A friend is working night shift in the reproductive health inpatient area. The staff there are mostly women in their early 20s. Apparently it would be hard to tell differentiate it from a slumber party. They all pull mats onto the floor of the lobby and chat, giggle, and sleep. I forgot to ask if there was much hair-braiding. Last night she took milk and cookies. Everynow and then they wake up and deliver a baby.

I caught one of the smaller medics standing near enough to the tape-measure attached to the wall. She came in at 4'8". She's on the small side, but not unusually so for around here.

My Muay Thai career is taking off. I got my first black eye two days ago, though it's only a hint of purple around my upper lid. The worst part was trying to find my contact lense that was knocked out as well. Tonight I took a shot to the jaw that made chewing a bit difficult. It's rough enough that I feel like I'm boxing, but not so much that I worry about getting hurt. I think when I come home and people use headgear, mouthguards, and shin pads it will seem like a very tame sport.

This sort of stuff keeps it entertaining amidst the misery.

Sweet December

I haven't written in a while. Someone said a magic thing happens at around three months of being somewhere. People get to know you, the newness wears off, and you go into the "not leaving in two weeks" category that most volunteers fit into. I'm there, and am wondering where my two hours/day of reading medical stuff and daily naps went.

I'm slightly more able to talk to people now in Burmese and bits of Karen, and have worked with most people in the clinic (outpatient departments and all three shifts of each inpatient department). That means I can easily drop in and see patients anywhere, which is fun but time consuming. Some people are treating me like the neonatal intensivist, which is frustrating because most babies who are born sick don't do well, regardless of what you do for them.

I've eased into the monitoring and evaluation side of things, first doing minor work on two projects, and suddenly I have two fairly large ones that I'm basically on my own to do. Lately, I'm at the clinic until either 4 or six, and then spend the evenings working on reviewing the clini'cs TB data over the last year. Today I was talked into starting a one-month prospective study following patients referred to other clinics for TB testing and treatment (we don't do the treatment here) to see what our specificity is and simply how many of the patients make it to the other clinics.

Also, December is full of holidays. The clinic put up a stage in the middle of the grounds and it will be used at least every other night for the next few weeks. The first event was Nov. 30. Karen celebrate the beginning of the Christmas season on that date. It started out as karaoke and transitioned to a church service around 11pm with a birth of Christ reeneactment. Dec. 1 is World AIDS Day, which the clinic celebrated with a lady-boy review (drag show) interspersed with HIV education skits. The birthday of the King of Thailand is on Dec. 5th and is surrounded by days of festivities. Dr. Cynthia's birthday is the 6th. It's a crazy month. [I was interrupted by a friend saying that there is muay thai downtown for the next few nights...now I'm back, it's midnight again and I haven't accomplished anything since I left work]

I had a funny moment when I was showing one of the medics some photos on my laptop. It seems like many foreigners are from urban areas, so I like showing them pictures of the rural south so they don't get the wrong impression. I pointed out my car in one and she said "oh! so you really are very rich!" I didn't argue. She later said "I have never seen places like this," when looking at pictures of the appalachians. I asked if she hadn't seen mountains in parts of Burma and she said "Yes, we have mountains, but I am too lazy to walk up them." Priceless.

One real doctor is volunteering her time here for about a year. As far as I can tell, she never finished residency (or the Spanish equivalent) and went straight to work in Columbia during their civil war. She then ended up working for the international rescue committee and has been everywhere. Kosovo, Rwanda, Indonesia after the Tsunami, etc. It's inspiring. She loves it because one moment you are treating chronic conditions like hypertension, then you are treating TB, then amputating a limb. To me it seems like an extravagantly well-outfitted organization, but still she has run into things that no one can be completely prepared for.

Problems one can run into at the clinic

Here are a few things I've run into this week that help paint a picture of working here.

I'm a bit ashamed to say that I didn't notice this one, but a 3 y/o came in with malaria, accompanied by her sister who said she was 12, but we later found out that she is probably just 10. It never struck me as odd that no one else was with them. I'd like to say that I assumed a parent or some adult came by in the evenings, but I really just didn't notice. Someone did though and a group focused on child protection came in to talk to them. No family had been to see them during the entire 4(?) day admission. The ten year old said they were from a village outside of Myawaddy in Burma, but she didn't know how to get there from the clinic, and didn't know how to contact her father. They are children from a previous marriage and have no contact with their birth mother. It sounds like their new family doesn't pay much attention to them, although they at least do live with their father and new wife.

After talking it was decided that the organization could house them when the little girl was ready for discharge and hope the parents could track them down. Thankfully, another sister, also saying she is 12 came by and knows how to get home. She decided to stay until the girl is discharged. In the end, the child advocacy group is going to stay involved to help them get home and see if they can help the family in any way. In retrospect, I should have noticed that there were two kids basically on their own at the clinic.

More clinically, a few days into his stay a little kid with malaria and questionably hygiene (but with a parent present) told us of symptoms that warranted doing a urinalysis. It showed trace leukocytes and moderate blood. The differential is suddenly broadened to a kidney problem or UTI. OR, the test is completely meaningless because the leukocytes could be hygiene related and the moderate blood could just be from the malaria-related hemolysis. Without microscopy and fancier tests it's impossible to know what's up. But, since he had UTI symptoms we are just going to treat that and see how it goes. In retrospect, one might have foreseen the limited usefulness of a UA and just treated symptomatically from the beginning.

Some kids are abandoned at the clinic. One of these is now 6 months old and still lives in the reproductive health inpatient department. It's a busy department with maybe 15 staff there round the clock. He's basically the department's baby. At lectures someone is usually holding him or feeding him. When staff get bored they play with him.

Someone elsewhere in the clinic has been working to find a home for him and succeeded. The staff are in an uproar. They want to keep him. The senior medics have gathered them together and said "if you want him, take him home with you," and "he's not a puppy." However, further protest led to a department-wide meeting with clinic administrators to talk about it. I think the younger staff still want to keep him (collectively). Maybe they don't trust where he's going to, or maybe they just like sharing a baby (they are mostly unmarried women in their early 20s). I'm curious to see how it works out. I'm not sure what it would be like to be raised in the staff room of the clinic -- maybe not so bad, but he's probably better off elsewhere.

And one more quick one: Probably the sickest kid I've seen here yet came in today. While we were struggling to get an IV started to give some medicine one of the medics gestured towards the door where I saw a dog curled up against the wall. Someone was quickly dispatched to run her off and then we all got back to the task at hand.

Every day is an adventure.

Quick Muay Thai followup

I did some research on the pre-fight activities and of went first to wikipedia: http://en.wikipedia.org/wiki/Wai_khru_ram_muay

And then to YouTube: http://www.youtube.com/watch?v=OPK5JtxjIM0 although that is much longer and formal looking than what the guys were doing. A lot of the stuff on youtube is by tourists and so they really play up the ceremony part.

Here is a full fight that shows the rhythmic movements. In a similar (though nicer) venue to the we were at and using Burmese rules (no gloves): http://www.youtube.com/user/shwefist#p/u/1/1bH0fDjnfkI