Arrival/Orientation : Home.

My house is the Health Frontiers office. The office is downstairs, with a room for the files, printers, etc, and where our administrative assistant Novalinh works. There is a shared bathroom, kitchen, living room, and Dining / meeting room on the first level as well. The TV cabinet is well stocked with bootleg DVDs, so I will not have the opportunity to miss american media. Right now Christine and Amy are watching Glee and How I Met Your Mother, both of which were on my netflix queue at home. (Amy is the Pediatrics coordinator, here from Australia with her husband, Chris.)

Upstairs we have 2 guest bedrooms, another shared bath, and my room which is en-suite. I have an air conditioner, a fan, and a king sized bed, so I’m pretty much in the lap of western luxury. I do wish the ants would stop crawling into and out of my keyboard, and my mosquito screens aren’t 100% effective as one night I woke up with 2 mosquito bites, but other than those two things, my room could just as easily be in America.

We have a housekeeper, Ning, who works 5 days a week, and a night guard and gardener, Pa, who works 6 nights a week. He has a day job too, so I think he just sleeps in his hammock on the front porch most of the time, but our gate is so creaky that anything big trying to get in would wake him up.

Last week I ate breakfast with Christine at Kung’s every day. Kung’s is down a little side alley about 3 blocks from our house, and Christine eats breakfast there every day. They do make a mean cafe Lao yein (coffee Lao cold) and a delicious sticky rice pancake (pancake mix with rice in it) filled with a slice of mango. Other breakfast options are omelet and french bread or french toast, which is really more like a cross between texas toast and french toast served with syrup and banana. All of them are tasty, and at 1600-1800 kip with coffee (2-2.25$) the price is right, but after 7 days, I was ready for some corn flakes and more fruit, so I may save Kung’s for lunch and weekend breakfast and eat at home for weekday breakfasts.

Lunch is Kung’s or Ning will cook for $3 each, with leftovers for dinner. Dinner tends to be leftovers or bread, cheese, and some kind of veggie from the nearby falang (foreigner) supermarket, unless we go out. In addition to Kungs, we have eaten at La Terrace - affordable decent French, Sticky Fingers - Australian pub comfort foods, a Vietnamese restaurant near the medical school where I had a standard vermicelli salad, and BFE which is near home and serves big safe salads and Lao food. I haven’t had any sticky rice or spring rolls yet, but plan to correct that deficit tonight or tomorrow. Pomello is in season, but I was out too late after our meeting this afternoon to buy any. I will get some more fruit this week!

Transport is primarily by bike - currently I am riding a chinese one speed with fairly poor rear brakes, but I have a new helmet and just take things slow. Christine will leave me her mountain bike when she leaves, which will be faster and safer. Biking is pretty much the same here as in America - you have to watch out for the cars and ride defensively. There are no bike lanes, but since there really aren’t well respected car lanes, and many more bikes and motor bikes, it’s less of a problem. To go to Setta or Mittaphab I must drive, however.

I am learning how to drive; last Monday I gave Novalinh, our administrative assistant, two passport photos and a copy of my MN drivers license. On Thursday, I received a laminated card with my name and one of the photos, which is my Lao drivers license and is good for one year. There are only 2 cardinal rules in Lao driving: 1) You’re responsible for what’s in front of you on the road - your lane, other lanes, pulling out from parking without looking, and oncoming traffic is included. (This might include pedestrians or animals and will almost certainly include motorbikes, and cars of all sizes, plus some decent sized trucks.) 2) Try not to hit anything. Lanes are marked but often don’t make sense, and are pretty much uniformly ignored. People stop at stop lights for the most part, though there is a lot of extending of yellow lights. (I entered the intersection near our house at the end of the yellow left turn arrow this morning. Two more cars behind me turned as well.) There is also something called the “Free right turn” which means you can turn right anywhere, any time, even at a red light in front of oncoming traffic. There are traffic circles more frequently than lights and Lao tradition is that people entering the traffic circle have the right of way. This is fairly universally respected, even when it causes at jam. (Eventually, no one can exit.) Stop signs are respected when convenient, but when they’ve been waiting a long time, eventually people just pull out in front of oncoming traffic, particularly at certain intersections, so you really have to watch them at certain spots. My general approach is just to drive slowly and cautiously and this seems to be working and accepted. Christine says people are pretty patient here, though some drivers are starting to get faster and more likely to honk or pass you. Either way, as a foreigner, I’m responsible for any accident I’m involved in (eg: drunk motor-scooter broadsides me when I have right of way - my fault) so caution is the best approach. The good news is our car is big - a 93 Isuzu extended cab pickup - and slow, and a stick which I prefer, so there will be minimal temptation to start going faster when I get used to the crazy traffic here.

At work, I will be expected to adopt the traditional Lao skirt - “sin.” It’s basically a tube of cloth that is about 1.5-2 times as big around which you overlap using snaps or hooks an eyes and makes a wrap skirt. Christine reports they are comfortable for bike riding. I was feeling discouraged because the ones I see people wearing are all black backgrounds or very dark green, blue, purple, maroon etc. These are colors I rarely wear in America, and I brought mostly light blue, purple, and green shirts. (My preferred palate.) However, Christine took me shopping this weekend and I picked out 4 nice ones with lighter, brighter colors including light blue, medium purple, and some nice medium pink and blue. I suppose I still won’t look truly Lao, but I’ll be sort of traditional and much happier than I would be in all dark colors. This week we’ll try to get into a tailor to actually get the skirts made.

As far as entertainment / sports goes - I played badminton this weekend - a hot endeavor, but with a roof so it can be played in the rain. I hope to take up tennis, so I may not continue going to badminton or I’ll get my swings all confused. I will be able to bike when it’s not raining, and once my backside gets all adjusted to biking again. I could join a gym for 300-600$/year, but I think I’ll see how I do with outdoor social sports and yoga first. There is a pretty big community of French and Australian aid workers and entrepreneurs here, so I don’t think it will be too hard to find friends.

Arrival and Orientaton - Work:

I am starting my second week in Lao. I arrived last Sunday (one week ago yesterday) after 29 hours in transit - I flew Denver-LA, LA-Bangkok (17 hrs) and Bangkok-Vientiane with a long layover in Bangkok. I left at 6:30PM on Friday and arrived at noon on Sunday.

I spent the first week getting to know the people and places I will be working. There are 22 residents in the internal medicine program - 8 interns and 7 second and third years. They rotate at 3 hospitals - Mahosot, Settarthirath, (Setta) and Mittaphab. Mahosot is the closest to my home, where I will give lectures on Thursdays, and where I will teach beginning English on Tuesday and Thursdays. There is pretty good teaching on cardiology, GI (which is actually more general medicine) and Infectious disease wards there, so I will probably not do much rounding at Mahosot. However, it is home to the majority of the senior Lao doctors involved in the residency program, so I should get to know it well.

Setta is likely where I will round most days - there are few internal medicine graduates there currently, so there is a need for teaching rounds. Right now the three residents at Setta speak good English, so we were able to understand each other last week. It will be more interesting when the residents with less English proficiency rotate through. Christine (my predecessor) speaks enough Lao to do half or more of the presentations in Lao, so I will be a challenge for the residents.The residents will pick out a few cases to review with me each day. Last week we saw AML with tumor lysis syndrome (there is no chemo here and even if there were neutropenic fevers would be a nearly insurmountable risk,) fever which was not dengue or rickettsia (two of the more common causes of fever,) and likely temporal arteritis with no ability to do biopsy confirmation and an ESR that had been ordered but not drawn, but improved with steroids. Since they save the hard cases for teaching rounds, it will probably often be challenging for me to figure out what if any recommendations I can give.

Mittaphab is the newest of the three hospitals, but looks the oldest, and is undergoing renovations and new construction, so we spent several minutes wandering around the basement looking for administrators who’s offices had been moved from the (now empty) administrative ward. It has a fairly good teaching structure with 3 general and one cardiology and one ICU team, all of whom have staff doctors that are internal medicine grads and round with the residents daily. There was good teaching happening there when we visited last week, so I will likely not spend a great deal of time rounding there.

I met many people last week - IM teachers, hospital directors, University of Health Sciences staff doctors who oversee our program and the medical school, and many of the medicine and pediatrics residents. I am sure I will not remember all of them, but hopefully they will be forgiving when we meet again. I also (theoretically) learned how to get many places. I am certain I can get to Mahosot (a few blocks by bicycle) and to the Thai-Lao friendship bridge (where I will pick up doctors from Thailand for grand rounds), and pretty sure I can get to Mittaphab. Today I will try to make sure I can get to Setta, where Christine and I can follow up on the patients we saw last week.

This week, I will start Lao lessons, teach my first Beginner english class to the residents, and give my first Thursday lecture (luckily, I get to use the first week to introduce myself.)