I felt the Sumatra quake today!

At 5:15 pm local time there was a 7.6 earthquake in Sumatra. At that time, I was laying in the hammock trying to marshal the energy to get up and prepare for my first muay thai class. I heard a rumble and then thought I felt something. Then I thought I must either be crazy or that the Burmese army had begun shelling something very nearby. Then I forgot about it. After checking CNN this evening I found that indeed there was a quake! And according to USGS people in Bangkok have reported feeling it.

The Thai boxing class was fun. I've mostly given up exercising on my own here, so it's nice to go somewhere and have someone tell you to keep jumping, kicking, punching or whatever. I have thought about picking up a new hobby while here, and this may be it. We'll see if I can walk tomorrow.

I've also figured out how to address the lack of calories in the average Thai and Burmese diets. On many street corners are carts that sell sausages of varying types. These are skewered on a stick, the sides are slashed (to let the grease in I guess), and then they are deep fried. This is covered in sweet and sour sauce. Each one costs about 20 cents.

This week I'm in adult inpatient. I'm still trying to figure out what to do with myself. The medics are pretty good. Most of the time when I say "have you thought about doing _______," they say "yes, and here's the reason we are not." I often disagree with the final decision, but don't argue because they have decent logic behind their actions, and generally the difference is just a matter of aggressiveness. I am typically in favor of a more aggressive approach, which never happens in the US. A few times though they've thought I had a good idea, or have seemed unsure and I, also unsure, at least came to the same conclusions as them. I think tomorrow I'm going get more involved and actually see and write notes on many of the patients on the ward. To this point I've just been 'following from a distance.'

In general, things are good. Each day crawls by, but weeks have passed quite quickly.

International Peace Day Activities

Today is World Peace Day, which I didn't realize, but a group of Thai and Burmese monks-in-exile led a walk through Mae Sot to the Burma border. I decided to join as they passed the clinic a few kilometers from the endpoint. I didn't exactly disobeying my cousin's advice to avoid political activities because this is more of a religious activity.

There were maybe two dozen monks leading the way with a hundred or more others following behind, many wearing orange shirts to match the monks robes. It was an official looking parade with Thai police escorting etc. It was meaningful to me to see people there who had been involved in past uprisings in Burma, specifically 1988 and 2007, and because of this had to flee to Mae Sot. It was miserably hot, and one of the monks said "If there is peace in your heart, you can stay out here all day, but we will not do that." The temperature isn't much different from Memphis, but I think that at this latitude the sun just hurts more.

There were people along the way taking pictures and videotaping. Many were sympathizers but some were likely with Burmese military intelligence. In the past I thought reports of their activities were exaggerated, but the more I learn the more accepting I am. An American friend working for another organization in town said she avoids things like this because she wants to keep a low-profile in hopes of not being refused a visa to Myanmar in the future. Apparently people who have their names attached to articles and reports relating to refugees are occasionally refused.

A documentary, Burma VJ, was recently released and features the Democratic Voice of Burma, a group of individuals who clandestinely recorded things in Burma with handheld cameras. They would often conceal the camera under their arm or in a wad of newspaper and simply record daily life and conversations with people. Often they would work far from home and with a false name so that if a member of the MI noticed them, they wouldn't be able to track them. Videos would then be sent electronically to Europe for processing.

This group's moment in the spotlight was during the protests in Sept. 2007. They were among the few to record what was going on, and captured footage of a soldier shooting the Japanese photographer Kenji Nagai in the back from three feet away. One scene I found very disturbing was well before the uprising. Much of what passed for protest would be one person standing up with a sign criticizing the government. DVB would be around to surreptitiously record it. In one example, within seconds of the man shouting out and lifting his sign, several men emerged from the crowd, passers-by who are informants for the MI, and wrestled him to the ground. Moments later an unmarked van pulled up and the man was carried into it.

My first week at the clinic

It is about 5:30 here and it's dropped from somewhere in the 90's to a breezy 83. From the porch I can see clouds piling up on the mountains of Burma about 2km away. The wind is shifting this way and will blow them on top of us for about 45 minutes of torrential rain. A housemate Daniel says we have about 30 minutes. The weather here is fairly predictable. During the rainy season it will rain all the time. Now towards the end, you just know not to plan anything or be out of doors between 5 and 7.

My first week at the clinic was good. I was in the reproductive health outpatient clinic, doing mostly routine prenatal screening and exams. It's not unlike the US -- similar testing (HIV, VDRL, blood typing, but not GBS), similar exam, similar vaccinations (except people in the US usually already have them). It's worth noting that I had one patient all week over 110 lbs and the only blood pressure I saw above normal was a systolic of 130.

Being a student is not unlike at home. You see patients and know what to do for many of them. If you don't, you ask someone else -- there aren't any doctors in the RH outpatient clinic, but some of the medics have been doing this for ten years or more. If the person you ask doesn't know, you figure out the safest of what you think are possibilities and tell them to come back soon if they don't feel better, then you go home and look it up.

The process of becoming a doctor is about learning lots of things. There are big conceptual things, but also a thousand discrete little things. For instance, what's the best way to clean out an ear that is completely packed with wax? When I saw a patient with that problem I didn't know. We sent her home with an antibiotic for the infection she was incubating back there, tylenol for the pain, and instructions to do frequent saline soaks/rinses. I now know that I could have done a 30 minute soak, fashioned a pressure-washer out of a syringe and IV cannula, and used that and a toothpick to gently clean things out. One advantage of being here for a year is that I'll see an extra thousand or so patients and learn all this trivia so that when I'm an intern and presented with similar situations I'll be able to act with confidence.

This is a rather cynical comment but often seems true: the funny thing about academic medicine is that sometimes the attending doesn't really know what to do or doesn't have evidence to back up what he/she prefers, but the student/intern is always wrong. If I were doing the above irrigation and the attending asked what I was doing, a reply of, "I don't know, it just made sense," would lead to a brow-beating. If I said "according to the Journal of American Family Physicians this is the best thing to do," I might get a response (especially from an internist or pediatrician) like "never listen to what family doctors say," but it would not reflect poorly on my competency, although I could expect some 'good natured' harassment about reading how family medicine doctors do things. Another advantage of coming here for a while is not having to endure this scenario every day.

Anyway, life outside the clinic is also good. I'm starting to see what my time here might look like. I have something like 6-10 months. I can see spending a week in each of the outpatient clinics, a month in each of the four inpatient wards, and six weeks (maybe more?) working with a local (though renowned) malaria research group. That gets me well into the 6-8 week range without repetition, and then I can either go home or repeat things.

Today I went to a meeting of the group I worked with two years ago. They are doing well, and it was good to see familiar faces. As their situation has changed it seems like the group has reorganized and re-focused well. I've volunteered to help the new technical adviser with grant writing so I can still be involved and learn a little bit about the funding of these sorts of ventures.

I think the only other big news is that I have a new bike. I didn't want to, but a shady bike chop-shop had far and away the best bikes and deals. The word around town is that it's where the police sell all the bikes they 'confiscate' and turn an unofficial personal profit. However, all 5 gears work, the bottom bracket is tight and recently greased, it rides quietly. None of the above were available at the price from the other used bike shops (which were lean-to's in the Muslim district).

As a last bit of trivia, I have read that the Muslim folks followed the trade as land routes to this area opened up. Historically they have been traders and made up a merchant class in between the indigenous people and the colonizers. Things aren't as regimented as they once were, but evidence remains. I've found they are the most pleasant people to do business with. In Thailand there are many people trying to rip off foreigners. I have never gotten that impression in the Muslim area. It's more like they really want me to be happy with what I get and will repair it when it falls apart in a few days. The bargaining process is just something you do. I often feel like it's end-point is obvious from the beginning, and more persistence from either party might change it by a few percent, but I don't feel like they are genuinely trying to persuade me to spend $50 on fake gems or similar. However, I did buy from the corrupt cops.

Mae Sot!

The trip to the train station was difficult but otherwise uneventful. I was dripping sweat at 6 am when i made it up the flights of stairs to my platform. By 6:30 I was at the station. The previous night I asked a bilingual person how to communicate to a taxi driver that I needed to get the few blocks from the train to the bus station. She wrote "Terminal Bus" in English on a piece of paper and told me to give it to him. I have tried saying that, in addition to sathaanii rot meh which I think means bus station in Thai, to various people and got only blank stares. I realized that people are used to seeing English but have little idea what it might sound like.

The bus terminal has always been a maze to me. Many private companies have stalls in a large building. Outside are about two acres of buses waiting to leave. Inside there is abundant signage, 98% in Thai. I find a booth with service to Mae Sot but the next bus is at 9:00. I try to find another company with an earlier bus but promptly return for that ticket after a few brief moments being crushed by the burden of my things and the heat.

The bus station smells faintly of excrement, but the smell seems consistently distributed around the place, enough so that I check my shoes and bags to make sure the source isn't following me. A number of stray dogs seem to roam the place unchecked, possibly giving source to the smell. At 8:00, music is played over the speakers and everyone stands. The TVs flip to images of the king and the nation's successes. What is apparently the national anthem begins to play as everyone stands and the dogs howl along. It was quite the scene.

The 6.5 hour bus ride was uneventful. They showed a movie at the beginning, featuring a thai star not unlike Jackie Chan and showing restraint similar to a Tarentino film. It was entertaining even without understanding any of the dialogue, though 'entertaining' takes on new meaning when trapped in a seat for hours on end.

My new home is large two story house with 5 bedrooms, four of which are currently occupied. Most of us work at the clinic with one other helping the management of a local store that sells art and other things made by or related to Burmese refugees. It has wireless internet, sit-down toilets, and a host of geckos. What more does one need? I've just been laying around all day, running a few errands. I'll start at the clinic on Monday.

In Bangkok

There is a sign near the entrance of the royal palace that warns to "Beware of Wily Strangers." This time through Bangkok I've done a better job. My first time I was ripped off by one guy and almost another. Lessons learned. BKK seems much more navigable this time around. Last time I arrived completely ignorant of all things Thai. I'm still mostly ignorant, but feel much more comfortable.

The trip here was long but uneventful. I thought I was doing well adjusting to the time difference, but got really sleepy around 2:00 this afternoon and slept until just after sunset. It's now around 8pm and I feel like it's 3 in the morning. It doesn't help that it's raining hard and the streets are quiet.

The highlights so far have been walking around Wat Phra Keo this morning, the breakfast at the hostel which was just a huge table of really good fruit, and watching the rain pour on the surprisingly verdant alley the hostel is on while sitting on the floor at my table and eating really good food.

One thing struck me while going through the Wat. Buddhism at its most basic is simple. A guy was thinking about life and came up with the Four Noble Truths and then spent the rest of his life trying to use those to alleviate suffering. No god(s), no external sacred things, no need (to my knowledge) for temples. However, it's now a vastly complicated religion involving temples, shrines, idols, relics etc. I think it must be inherent in human nature to need superstition.

Tomorrow I lug about 90 pounds of stuff to Mae Sot, which will include carrying it at least a half-mile and maybe four flights of stairs...in addition to the 10 hour bus ride. But then I'll be there.