Apparently, at one of the wats near our house, there was some construction going on and something collapsed revealing tens of small Buddha statues, that are presumably old, since no one knew they were there. This is likely not an actual miracle, as someone probably buried them at some point, accidentally or purposefully, but it is the closest I’ve lived physically to any sort of religious happening. Tomorrow, I plan to go visit and try to see these Buddhas, as I hear they are quite attractive. (Oh, and get used to the Wat puns, I anticipate they will keep coming.)
I learned about the small Buddhas from my first independently-acquired friend in Vientiane. I have not lacked for social engagements or opportunities since getting here to Vientiane, but all of them have been with people that Christine or Chris and Amy are friends with, and you never know whether you’re being invited to stuff because people want you to come, or if they feel obligated. And I sense that there is some degree of visitor / short term guest fatigue that sets in amongst the people who have been here for several years. I don’t know if it would bother me, but I can see how many people would just get tired of meeting and getting to know new people at some point. So I am happy to have independently found a friend, because I was feeling a bit frustrated / worried. Although, when I think about it objectively, how many non-med school classmates and non-relative friends did I have a month after moving to Minnesota? The answer is zero, but I think I feel more pressured here because I am probably only here for a year so I need to get started. :)
Tanja is a Swiss doctor visiting Vientiane for 3 months to finish the 2 years and 3 months of work abroad she needs to do to qualify as a specialist in tropical medicine in Switzerland. Yes, MN friends, that is 2.25 years abroad. We are lucky with our 2 month requirement from ASTMH. She is also a pretty cool person. Her first year abroad was in the Congo with MSF. I told her I was impressed and I didn’t think I’d be brave enough to go to the Congo, and she replied that she really felt quite safe there. She was re-building an old Belgian hospital that had been destroyed in the civil war, doing clinical care, and training local MDs. The area was accessible only by bush plane or extended (many days) over-land journey. It sounds like it was an incredible experience, though in some ways very frustrating because of very limited resources. She was evacuated once, but she thinks MSF was maybe too aggressive about taking people out of potentially dangerous situations. That’s reassuring, I guess. Her second year abroad was in French Guyana where she had great resources and equipment, but struggled with the poorly trained and un-motivated to learn doctors. I think this supports my theory that patients and doctors are unsatisfied to some degree with their medical care system worldwide, no matter where it is. It’s not much comfort, but sometimes when you’re really frustrated with your situation at home, it’s a little. Her first impressions (after 2 weeks) is that the Lao doctors are really eager to learn and provide good care with limited resources. I think this is true in my experience as well, and since she’s on a ward with several of ‘my’ residents, I’m happy to hear she is impressed. And to be fair, the ID ward she is on has limited diagnostic resources, but Paul, the lab director and ID specialist seems to have picked those resources very well to tailor to accurate diagnosis and timely treatment of the problems they see most often here.
The Australian rules Football Grand Finals was very fun - somehow heckling is so much more enjoyable with crazy Australian slang and accents. And it’s a game that can actually be pretty edge-of-your-seat exciting, and worth heckling. This game in particular - it was tied at least twice in the last quarter with the last (and tying) goal being kicked in the last 2 minutes of play. There is no overtime, so we get to watch _another_ grand finals match next Saturday. From my perspective this is awesome, though of course the people who were rooting for a favorite team are pretty disappointed. Next weeks game probably won’t be as close or exciting, but we can hope. We are not sure if Chris will actually come home this week - he may stay if he can get a ticket for next Sunday’s match. We will miss him at resident’s games next Saturday morning, but will understand if he stays in Australia.
Saturday, September 25, 2010
Friday, September 24, 2010
The letter R
There is no R sound in Lao. My understanding is that they used to have an R, but they got rid of it. It seems kind of harsh to me to just get rid of a letter all together, but they must have had their reasons. . . Thai has an R, though, so my residents and english students know how to say R, they just often forget to. And it does make some words more fun - curriculum, for example, sounds much more musical as culiculum. My Lao is very slowly improving. I know most of the question words now, usually understand numbers if repeated slowly, and am starting to recognize words here and there on the wards. There are still tonal differences that I will probably never be able to fully hear, much less replicate, and differences in the length of consonants that I struggle with. (For example if you say you are very tired incorrectly, you are saying that you have a lot of pubic hair, and if you say “I’m going to eat pork for dinner” but linger too long on the word pork, you’ve said that you are going to eat your friend for dinner.) The good thing is that there are no tenses to memorize and verbs are not conjugated depending on who they refer to. I’ve been struggling to teach irregular verbs to my english students, so I’m glad I don’t have to learn them in another language too.
Last Friday I watched one quarter of the Australian football semifinals. Australian football turns out to be way cooler than american football - it requires actual athletic skill; both cardiovascular fitness and coordination to kick and run with the ball. And it is not interrupted every 30 seconds for some esoteric rule. I hope to watch the grand finals with Amy tomorrow - Chris is leaving tonight at 9 and flying home for the game, because his team is playing and he won a free ticket in the lottery. He has never seen them win a grand final (though he has been to two grand final games) and his whole family are die hard fans and members of the athletic club the game is being played at. Given that his team won the semi-finals game by a margin of 60 points, (and only because they relaxed somewhat for the last quarter, which they started with a lead of about 80 points) I am hopeful that he will get to watch them win this year. And also that he gets there on time - he only has 3 hours from the time his plane is scheduled to land until the game starts!
I never thought, after all those months on the medicine firms at the U, that I would wish I could have more patients who got ERCPs. But I do. This week, I have seen 3 patients that have common bile duct stones and none have had anything done about it. The surgeons said they would operate on the first one, but then they waited over last weekend and monday he was septic so they transferred him back to medicine. As the intern was writing orders to start antibiotics for ascending cholangitis, his family was trying to decide whether they should take him home now, because it would be hard to get him home if he died in the hospital, or to let him stay and start antibiotics. On one hand, he did have elevated AFP levels and likely cirrhosis, so he might die in the next months - year anyway, but on the other, he had a very treatable problem which would likely be fatal if he doesn’t get IV antibiotics and ultimately have the stone removed. I really wished that he had gotten his surgery on friday. The second patient came with a month of right upper quadrant pain, not one but 2 ultrasounds confirming a CBD stone and dilation, and had been refused surgery because he was septic 2 weeks ago at his second presentation. He was treated for ascending cholangitis and discharged to home with plans for an elective cholecystectomy in a few weeks. He came back, still on antibiotics, no longer febrile, and with ongoing pain and was refused surgery because he had elevated liver function tests. Gee, I wonder if that could be due to the bile backing up into his liver and irritating it? A third ultrasound confirmed that the stone was still there, causing trouble. My resident and I agreed that if after being offered a second chance to surgerize him at Setta he was not accepted he would be sent to Mahosot, where there is a GI specialist that can do some ERCP, and/or maybe (Hopefully?) has a good relationship with a surgeon. The third was a similar story - a woman with a CBD stone and fever, who was initially refused surgery due to sepsis, and then the surgeons wanted to send her home for a couple weeks before operating. I didn’t anticipate running into the age-old medicine vs. surgery debate here as quickly and throughly as I have, and I feel somewhat adrift as to what to do. At home, I would try to talk to the surgeons personally, (Or have my staff call their staff) but here I’m pretty sure that would be inappropriate, plus I don’t speak Lao, so I actually can’t talk to them. And there is clearly a pattern of decision making emerging, so I don’t want to ask my residents to confront or try to explain to them, knowing that they probably need to preserve good relationships with their surgery colleagues for the benefit of future patients. So I’m pretty much left encouraging the patients to go to the “GI hospital” if they get discharged and have recurrence of symptoms (which they almost certainly will) and praying that some of those stones magically work their way out on there own. I’m not an optimist, or good at not being in control, so these are not great options for me.
Last Friday I watched one quarter of the Australian football semifinals. Australian football turns out to be way cooler than american football - it requires actual athletic skill; both cardiovascular fitness and coordination to kick and run with the ball. And it is not interrupted every 30 seconds for some esoteric rule. I hope to watch the grand finals with Amy tomorrow - Chris is leaving tonight at 9 and flying home for the game, because his team is playing and he won a free ticket in the lottery. He has never seen them win a grand final (though he has been to two grand final games) and his whole family are die hard fans and members of the athletic club the game is being played at. Given that his team won the semi-finals game by a margin of 60 points, (and only because they relaxed somewhat for the last quarter, which they started with a lead of about 80 points) I am hopeful that he will get to watch them win this year. And also that he gets there on time - he only has 3 hours from the time his plane is scheduled to land until the game starts!
I never thought, after all those months on the medicine firms at the U, that I would wish I could have more patients who got ERCPs. But I do. This week, I have seen 3 patients that have common bile duct stones and none have had anything done about it. The surgeons said they would operate on the first one, but then they waited over last weekend and monday he was septic so they transferred him back to medicine. As the intern was writing orders to start antibiotics for ascending cholangitis, his family was trying to decide whether they should take him home now, because it would be hard to get him home if he died in the hospital, or to let him stay and start antibiotics. On one hand, he did have elevated AFP levels and likely cirrhosis, so he might die in the next months - year anyway, but on the other, he had a very treatable problem which would likely be fatal if he doesn’t get IV antibiotics and ultimately have the stone removed. I really wished that he had gotten his surgery on friday. The second patient came with a month of right upper quadrant pain, not one but 2 ultrasounds confirming a CBD stone and dilation, and had been refused surgery because he was septic 2 weeks ago at his second presentation. He was treated for ascending cholangitis and discharged to home with plans for an elective cholecystectomy in a few weeks. He came back, still on antibiotics, no longer febrile, and with ongoing pain and was refused surgery because he had elevated liver function tests. Gee, I wonder if that could be due to the bile backing up into his liver and irritating it? A third ultrasound confirmed that the stone was still there, causing trouble. My resident and I agreed that if after being offered a second chance to surgerize him at Setta he was not accepted he would be sent to Mahosot, where there is a GI specialist that can do some ERCP, and/or maybe (Hopefully?) has a good relationship with a surgeon. The third was a similar story - a woman with a CBD stone and fever, who was initially refused surgery due to sepsis, and then the surgeons wanted to send her home for a couple weeks before operating. I didn’t anticipate running into the age-old medicine vs. surgery debate here as quickly and throughly as I have, and I feel somewhat adrift as to what to do. At home, I would try to talk to the surgeons personally, (Or have my staff call their staff) but here I’m pretty sure that would be inappropriate, plus I don’t speak Lao, so I actually can’t talk to them. And there is clearly a pattern of decision making emerging, so I don’t want to ask my residents to confront or try to explain to them, knowing that they probably need to preserve good relationships with their surgery colleagues for the benefit of future patients. So I’m pretty much left encouraging the patients to go to the “GI hospital” if they get discharged and have recurrence of symptoms (which they almost certainly will) and praying that some of those stones magically work their way out on there own. I’m not an optimist, or good at not being in control, so these are not great options for me.
Sunday, September 12, 2010
Wat?
Buddhist temples are called wats. They are all over Vientiane. Literally, like every 3 blocks. I’ve only been in a couple, but if I wanted to go to one a week for the next year, I feel confident that I would not have to go back anywhere. The day I arrived, Christine took me to a wat near our house and showed me some monkeys she can hear at night. (I haven’t heard them, or haven’t recognized them as monkey sounds.) They were pretty cute, but unfortunately, I was so tired and disoriented from the 29 hour journey, that I have no idea which of the 3 wats within a 2 block walk of our house (one north, one south, and one east) they live in. In fact, I’ve found that while Christine showed me many useful places (the department store, the DVD store, and the book store amongst others) that afternoon, I have been unable to return to an of them without getting directions again. It was still a nice tour, though, and a good way to stay awake until sunset, so I didn’t have major jet lag. (I slept till 5AM the day after I arrived, which was a new record for sleeping in according to Christine)
(The monkey!)
Yesterday, I visited the That Luang, (Stupa Yellow) which is the national emblem of Lao and has a Wat on either side of it. The that is a tower that rises 45 meters and is painted gold. It is actually a temple as well, and the distances and heights are symbolic in Buddhism, as are the numbers of things (a certain type of stones, lotus petals on top of the walls, etc. There are also 4 prayer halls, one facing north, south, east and west. I got there at about midmorning and it was threatening to rain so there were lots of interesting lighting and cloud changes during my visit. My favorite part was the Naga, or giant snake, which seems to be a common theme, and aside from flat walls, there was pretty not many things that didn’t have a naga - stairs, roofs, etc.
(The That Luang)
Just as I was leaving the That Luang (which cost 5000 kip, or 62 cents to get into) it started to sprinkle, and it looked like soon it would be down-pouring. So I popped across the street to the wat to the south of the monument, where I took of my shoes and sat in the main temple building under the roof for 15 or 20 minutes while it rained. This wat had a high, steeply arched roof with wide overhangs, but only one side had a wall. So it was kind of like sitting in the rain, without getting wet. The wat compound had many other buildings - smaller, enclosed temples, a giant Budda statue on the second floor of an open walled pavilion-like structure below, several other pavilions with many buddha lined up sitting and standing, and some enclosed buildings that must be housing for the monks. (In fact, one of our residents is living at a temple, so I know there is housing in the compound.) Inside the main wat, there are beautiful paintings on the ceiling, which presumably depict stories from the life of Buddha. I will have to read more about that, so I can understand them better. In the middle of the one enclosed wall is and alter, and to one side is a sort of pulpit, though this one appeared to be used for storage currently. At least 2 other groups of falang joined me to wait out the rain, and we all sat in silent reflection, which was nice. After if stopped raining, I spent some time wandering around the temple complex and then over to the wat to the north of the That Luang. That one is enclosed, more like a traditional church or temple that I would think of, and I did not try the doors. There were some young hooligans setting off fireworks in a pop bottle, so I spent less time at the second compound.
On the way back to the bike parking, I detoured past a monument at the other end of the parking lot. It was a white pillar with friezes around the bottom, and a big bouquet of roses form the president of India (who I later learned is in town.) The friezes seemed to depict the history of Lao, including pre-industrial times, the civil war, and the new, communist state of harmony. It was pretty cool, but it was looking like rain again, so I got back on my bike and pedaled down the hill to the Swedish baking company, which serves the best pizza in town. I really need to get on their delivery map. I went past the market on the way home, succeeded in buying 2 pair of shoes, and felt like I had accomplished quite a bit.
(The monkey!)
(The That Luang)Just as I was leaving the That Luang (which cost 5000 kip, or 62 cents to get into) it started to sprinkle, and it looked like soon it would be down-pouring. So I popped across the street to the wat to the south of the monument, where I took of my shoes and sat in the main temple building under the roof for 15 or 20 minutes while it rained. This wat had a high, steeply arched roof with wide overhangs, but only one side had a wall. So it was kind of like sitting in the rain, without getting wet. The wat compound had many other buildings - smaller, enclosed temples, a giant Budda statue on the second floor of an open walled pavilion-like structure below, several other pavilions with many buddha lined up sitting and standing, and some enclosed buildings that must be housing for the monks. (In fact, one of our residents is living at a temple, so I know there is housing in the compound.) Inside the main wat, there are beautiful paintings on the ceiling, which presumably depict stories from the life of Buddha. I will have to read more about that, so I can understand them better. In the middle of the one enclosed wall is and alter, and to one side is a sort of pulpit, though this one appeared to be used for storage currently. At least 2 other groups of falang joined me to wait out the rain, and we all sat in silent reflection, which was nice. After if stopped raining, I spent some time wandering around the temple complex and then over to the wat to the north of the That Luang. That one is enclosed, more like a traditional church or temple that I would think of, and I did not try the doors. There were some young hooligans setting off fireworks in a pop bottle, so I spent less time at the second compound.
On the way back to the bike parking, I detoured past a monument at the other end of the parking lot. It was a white pillar with friezes around the bottom, and a big bouquet of roses form the president of India (who I later learned is in town.) The friezes seemed to depict the history of Lao, including pre-industrial times, the civil war, and the new, communist state of harmony. It was pretty cool, but it was looking like rain again, so I got back on my bike and pedaled down the hill to the Swedish baking company, which serves the best pizza in town. I really need to get on their delivery map. I went past the market on the way home, succeeded in buying 2 pair of shoes, and felt like I had accomplished quite a bit.
Saturday, September 11, 2010
Free Right Turn
I still can’t decide if I approve or disapprove of “Free Right Turn.” It’s actually kind of nice when you’re turning right, but it can be pretty annoying when you’re going straight. This week was my first real week alone. Last week Christine let me manage things alone, but she was still here to answer questions. Now, she is gone. Things went well Monday through Thursday morning.
(If you’re a non-doctor an annoyed by doctorly discussions, skip the next 2 paragraphs.)
Monday through Thursday mornings, I went out to Setta and rounded with the two residents out there. They are both quite good, and I am lucky they both have decent English skills, so they can present in English. I still saw some disturbing patients. I saw at least 2 young women that were septic by vitals criteria (including pretty severe tachypnea), one on no antibiotics and the other on 2 antibiotics for 4 days (clearly, not the right ones.) One went to the ICU and the other was better the next day after being treated for Rickettsia. The ICU is apparently not a good place to go, (It is not staffed by Medicine residency grads) and last I checked, no one knew what had happened to that patient. The part that was disturbing, though, was that there is really not a sense of urgency. I look at a 27 year old woman with a fever and respiratory rate of 35 and want something to happen right away (blood cultures, antibiotics, etc.) The Lao doctors may have the right plan, but not in the appropriate timeline. To be fair to our residents, I think it is an endemic problem, and even if they really tried hard to do things quickly, I think the staff supervising them, the nurses, the radiologists, pharmacists, etc would make it impossible. Still, it’s frustrating to see young, previously healthy patients with treatable problems not being treated. I also saw a 2 week old hemorrhagic stroke. The patient had sudden onset of R sided HA 2 weeks ago, which as constant, and some L sided weakness on exam. We saw him wednesday and the resident got a CT (with and w/o contrast!) which showed fairly extensive R sided intraparenchymal bleed. I realized I’ve never diagnosed a hemorrhagic stroke because in America, people get stat CTs in the ED and go to neurosurgery if they have a bleed. The residents were planning to refer him to Mittaphab where they have neurosurgeons, but they weren’t sure he was going to go on Thursday. Fortunately, his exam was stable.
Tuesday I went for case review and topic review (prepared by the residents.) They reported there was a visiting Cardiologist, so this had been cancelled. I went to see what the cardiologist was teaching on. The topics were good - HTN, Ischemia, anticoagulants, anti-arrythmics. (They start digoxin here for clinical heart failure, regardless of EF, without any monitoring. Luckily, most patients probably don’t stay on it longs since they’re paying for their own meds.) The lectures were in french with Lao translation. Tuesday happened to be anticoagulation, and while the info presented seemed to be factually accurate (Turns out medical french isn’t that different from medical English, so I could understand quite a bit from reading the slides); I am not sure how relevant it was to practice here. There was discussion of the various parinuxes and irudins, none of which are available here. There was discussion of indications for warfarin, which I know the residents already know because last week they asked me how they could dose it for a-fib without INR monitoring. Oh, right, there’s no INR monitoring. Not really necessary to teach about warfarin in depth then, eh? Maybe the other days were better, though. I did my english teaching as usual, but my thursday lecture was cancelled - there was poor attendance and the residents who did come were looking a bit glazed from the 3 hours of cardiology lecture each of the 4 previous afternoons. I can’t say I blame them.
Friday was Khon Kaen Grand rounds. We were fortunate to have a lovely young geriatrician from Thailand come and talk to the residents about delirium and dementia in the elderly. I don’t think there is any structured geriatrics teaching in Lao. (Indeed, there are no geriatricians yet.) So it was a good exposure for them. Unfortunately, it was also a lot of organization for me. I had to get the handouts printed before Friday, drive to the border Friday morning, then drive back and take the visiting MD to Mahosot to round, then host lunch (Ning cooked) and then bring her to the lecture room. Of course I forgot to check the gas tank (I fill it so infrequently on Gordon it didn’t even occur to me to look) and noticed just as we were getting back to town from the border that it was on E. So we didn’t have very much time to round, and the poor Thai doctor got an exciting trip to the Shell station as part of her visit. Then I forgot the handouts when we went to the lecture hall, so had to come back and get them. Fortunately, she was very patient with my deficient hosting skills, and hopefully by next month I will be more settled and capable.
I had my first Lao lesson Monday. My teacher seems very good, but unfortunately the Friday lesson was cancelled. I shall practice my flash cards this weekend. I went out for Indian food Friday night with Amy and Chris. It was delicious, and 68,000 kip (<10 dollars) for all three of us. I lowered the seat on Christine’s mountain bike so I can ride it, and aside from some difficulty adjusting to a man’s frame, that is going well. I rode up the river 15 minutes earlier this week, and then to the That Luang today. After having a basket incident that required repair, I have returned to the one speed bike for around town errands - it has a basket which is more convenient and I am really not sure how Christine was getting on the mountain bike in her sin (Lao skirt) but I am not confident enough to try yet. The one speed seems to be the perfect speed for in town riding anyway. I have worn 3 of my 4 new Sin and gotten positive comments on them from the Lao. “Teacher, you are very beautiful today, you look like Lao.” I’m not sure whether to be frustrated by the reluctance to acknowledge foreign or different things as potentially beautiful, or impressed by the lack of eager and universal conformity to western (and quickly becoming global, sadly) ideals of beauty.
(If you’re a non-doctor an annoyed by doctorly discussions, skip the next 2 paragraphs.)
Monday through Thursday mornings, I went out to Setta and rounded with the two residents out there. They are both quite good, and I am lucky they both have decent English skills, so they can present in English. I still saw some disturbing patients. I saw at least 2 young women that were septic by vitals criteria (including pretty severe tachypnea), one on no antibiotics and the other on 2 antibiotics for 4 days (clearly, not the right ones.) One went to the ICU and the other was better the next day after being treated for Rickettsia. The ICU is apparently not a good place to go, (It is not staffed by Medicine residency grads) and last I checked, no one knew what had happened to that patient. The part that was disturbing, though, was that there is really not a sense of urgency. I look at a 27 year old woman with a fever and respiratory rate of 35 and want something to happen right away (blood cultures, antibiotics, etc.) The Lao doctors may have the right plan, but not in the appropriate timeline. To be fair to our residents, I think it is an endemic problem, and even if they really tried hard to do things quickly, I think the staff supervising them, the nurses, the radiologists, pharmacists, etc would make it impossible. Still, it’s frustrating to see young, previously healthy patients with treatable problems not being treated. I also saw a 2 week old hemorrhagic stroke. The patient had sudden onset of R sided HA 2 weeks ago, which as constant, and some L sided weakness on exam. We saw him wednesday and the resident got a CT (with and w/o contrast!) which showed fairly extensive R sided intraparenchymal bleed. I realized I’ve never diagnosed a hemorrhagic stroke because in America, people get stat CTs in the ED and go to neurosurgery if they have a bleed. The residents were planning to refer him to Mittaphab where they have neurosurgeons, but they weren’t sure he was going to go on Thursday. Fortunately, his exam was stable.
Tuesday I went for case review and topic review (prepared by the residents.) They reported there was a visiting Cardiologist, so this had been cancelled. I went to see what the cardiologist was teaching on. The topics were good - HTN, Ischemia, anticoagulants, anti-arrythmics. (They start digoxin here for clinical heart failure, regardless of EF, without any monitoring. Luckily, most patients probably don’t stay on it longs since they’re paying for their own meds.) The lectures were in french with Lao translation. Tuesday happened to be anticoagulation, and while the info presented seemed to be factually accurate (Turns out medical french isn’t that different from medical English, so I could understand quite a bit from reading the slides); I am not sure how relevant it was to practice here. There was discussion of the various parinuxes and irudins, none of which are available here. There was discussion of indications for warfarin, which I know the residents already know because last week they asked me how they could dose it for a-fib without INR monitoring. Oh, right, there’s no INR monitoring. Not really necessary to teach about warfarin in depth then, eh? Maybe the other days were better, though. I did my english teaching as usual, but my thursday lecture was cancelled - there was poor attendance and the residents who did come were looking a bit glazed from the 3 hours of cardiology lecture each of the 4 previous afternoons. I can’t say I blame them.
Friday was Khon Kaen Grand rounds. We were fortunate to have a lovely young geriatrician from Thailand come and talk to the residents about delirium and dementia in the elderly. I don’t think there is any structured geriatrics teaching in Lao. (Indeed, there are no geriatricians yet.) So it was a good exposure for them. Unfortunately, it was also a lot of organization for me. I had to get the handouts printed before Friday, drive to the border Friday morning, then drive back and take the visiting MD to Mahosot to round, then host lunch (Ning cooked) and then bring her to the lecture room. Of course I forgot to check the gas tank (I fill it so infrequently on Gordon it didn’t even occur to me to look) and noticed just as we were getting back to town from the border that it was on E. So we didn’t have very much time to round, and the poor Thai doctor got an exciting trip to the Shell station as part of her visit. Then I forgot the handouts when we went to the lecture hall, so had to come back and get them. Fortunately, she was very patient with my deficient hosting skills, and hopefully by next month I will be more settled and capable.
I had my first Lao lesson Monday. My teacher seems very good, but unfortunately the Friday lesson was cancelled. I shall practice my flash cards this weekend. I went out for Indian food Friday night with Amy and Chris. It was delicious, and 68,000 kip (<10 dollars) for all three of us. I lowered the seat on Christine’s mountain bike so I can ride it, and aside from some difficulty adjusting to a man’s frame, that is going well. I rode up the river 15 minutes earlier this week, and then to the That Luang today. After having a basket incident that required repair, I have returned to the one speed bike for around town errands - it has a basket which is more convenient and I am really not sure how Christine was getting on the mountain bike in her sin (Lao skirt) but I am not confident enough to try yet. The one speed seems to be the perfect speed for in town riding anyway. I have worn 3 of my 4 new Sin and gotten positive comments on them from the Lao. “Teacher, you are very beautiful today, you look like Lao.” I’m not sure whether to be frustrated by the reluctance to acknowledge foreign or different things as potentially beautiful, or impressed by the lack of eager and universal conformity to western (and quickly becoming global, sadly) ideals of beauty.
Sunday, September 5, 2010
New Experiences
Maybe my favorite moment of many good ones this week was when I was too tall to be in the front row for our group photo with the senior Lao doctors at Christine’s going away dinner. Not only was I too tall to stand in front of any of the attendees without obstructing their view, but I may not have been the shortest person there. Maybe I’m more sensitive about my height than I think I am. . .
I drove to Setta by myself 4 times this week. The first time I missed the last turn and on Thursday I went right at the first round about on the way home, but given the absence of street signs, I think I did pretty well. I also learned 2 new things about driving. The first is that a turn signal on a motor scooter is actually less helpful than nothing. The baseline status of motor scooters here is that they could turn left or right at any time. If you drive based on that assumption things seem to go well. When a motor scooter has their turn signal on it either means that they have recently turned or that they might at some point in the future turn. So basically, it means nothing but if you mistake it for meaning something, you may be wrong. (Like, that right turn signal means that they will be turning right, and then they turn left right in front of you.) The second thing I learned is that red lights only apply at moderate-high traffic times. Red lights during low traffic times are uniformly ignored. Sometimes people have the courtesy to flash their lights before running them. And they usually slow down, but not always. Exciting!
In Lao, your nick name might be “fatty” (Dtui) if you’re very skinny. The Lao are not generally a particularly bulky group of people, so there are quite a few people nicknamed Dtui. One of our residents is nicknamed Dtui, but because he is actually pretty giant compared to his colleagues. Tall, and what would be considered overweight in America, but is obese by Lao standards. On Thursday night, my lecture was “Introduction to Dr. Libby,” and then I had the residents introduce themselves to me. Too get a little bit of a sense of who they were, and as an ice breaker, I asked them what their favorite foods were and what they liked to do on Saturday night. I picked directed questions because when Christine came, she asked them to write down one thing that no one in the room knew about them. She got a lot of “I love medicine” and a lot of “I have no secrets” but not a lot of personal info. So I directed them while still trying to encourage them to express themselves. It sort of worked. Almost everyone said their favorite food was Lao food, but about half of them expanded on this with a dish or two (Fish, chicken, and papaya salad were popular.) One of the interns who is quite skinny reported that he only drinks milk, which is why he is so skinny. I’m almost certain he was kidding. And then there was Dtui. His response started “ I like Lao food.” He then followed with “I like Japan food, I like Korean food, I like Falang food. . .” and so on. (Falang means white people.) It was funny. Many of them reported that they like to study on Saturday, but no one claimed that was the only thing they did on Saturday - some of them work (at pharmacies or small shops they own / manage), many like Karaoke, picnics, hiking, sports, watching TV, and of course shopping for the female residents. It was a good introduction.
We had two teachers meetings last week - the first with the chief residents (2nd and 3rd years elected by their classmates) and assistant director of resident education, and one with all the major Lao teachers and administrators. Most of the meeting both times was conducted in Lao, which is good because it means the Lao teachers are taking more responsibility for decision making and teaching. Since the ultimate goal is for the programs to be independent and sustainable without outside leadership or support, that is great. However, between two meetings mostly in Lao, rounding on the wards where presentations to me are in english, but communication with patients and colleagues is in Lao, and resident topic review and case presentation (which is in English on the screen but in Lao verbally) my ‘sincere’ active listening skills are getting a work out. The decision from the two teachers meetings was to go back to a monthly focus curriculum. This month is neurology month, so I’m preparing a talk on bacterial meningitis for this week.
I finally got some fruit. I succumbed and purchased at 17,000 kip mango at the Falang grocery store that is 1.5 blocks from home. That’s just over 2 dollars, which is what I would pay for a mango in Minnesota, but this was a giant, ripe, delicious mango, so I’ve reconciled it with myself. In fact, after the first one, I got a two pack the second time. They are yellow mangoes, more like the ataulfo mango sold at the coop than the orange ones I ate in Africa. I also tried pomello, which is like grapefruit but bigger, with bigger grains of fruit, and sweeter and milder. It is delicious, but somewhat hard to prepare. I also ate at “Nudle”, the new noodle take away that is 2-3 blocks from our house, and conveniently on the way home from the hospital after late lectures. Apparently, they have a giant noodle box costume that someone has been wearing to advertise the grand opening, though I have not been fortunate enough to witness this. Amy saw a smallish person manning the costume somewhat clumsily with a large British man tailing him/her and saying “take it slow. . .” last weekend. I am too hot in a skirt and t-shirt, so I don’t even want to think what it would be like inside a noodle box costume. But the noodles are good and the price is right ($2.25 for a box which is enough for at least 2 meals) so I anticipate I will become a regular, and one day will get to see the giant noodle box.
I drove to Setta by myself 4 times this week. The first time I missed the last turn and on Thursday I went right at the first round about on the way home, but given the absence of street signs, I think I did pretty well. I also learned 2 new things about driving. The first is that a turn signal on a motor scooter is actually less helpful than nothing. The baseline status of motor scooters here is that they could turn left or right at any time. If you drive based on that assumption things seem to go well. When a motor scooter has their turn signal on it either means that they have recently turned or that they might at some point in the future turn. So basically, it means nothing but if you mistake it for meaning something, you may be wrong. (Like, that right turn signal means that they will be turning right, and then they turn left right in front of you.) The second thing I learned is that red lights only apply at moderate-high traffic times. Red lights during low traffic times are uniformly ignored. Sometimes people have the courtesy to flash their lights before running them. And they usually slow down, but not always. Exciting!
In Lao, your nick name might be “fatty” (Dtui) if you’re very skinny. The Lao are not generally a particularly bulky group of people, so there are quite a few people nicknamed Dtui. One of our residents is nicknamed Dtui, but because he is actually pretty giant compared to his colleagues. Tall, and what would be considered overweight in America, but is obese by Lao standards. On Thursday night, my lecture was “Introduction to Dr. Libby,” and then I had the residents introduce themselves to me. Too get a little bit of a sense of who they were, and as an ice breaker, I asked them what their favorite foods were and what they liked to do on Saturday night. I picked directed questions because when Christine came, she asked them to write down one thing that no one in the room knew about them. She got a lot of “I love medicine” and a lot of “I have no secrets” but not a lot of personal info. So I directed them while still trying to encourage them to express themselves. It sort of worked. Almost everyone said their favorite food was Lao food, but about half of them expanded on this with a dish or two (Fish, chicken, and papaya salad were popular.) One of the interns who is quite skinny reported that he only drinks milk, which is why he is so skinny. I’m almost certain he was kidding. And then there was Dtui. His response started “ I like Lao food.” He then followed with “I like Japan food, I like Korean food, I like Falang food. . .” and so on. (Falang means white people.) It was funny. Many of them reported that they like to study on Saturday, but no one claimed that was the only thing they did on Saturday - some of them work (at pharmacies or small shops they own / manage), many like Karaoke, picnics, hiking, sports, watching TV, and of course shopping for the female residents. It was a good introduction.
We had two teachers meetings last week - the first with the chief residents (2nd and 3rd years elected by their classmates) and assistant director of resident education, and one with all the major Lao teachers and administrators. Most of the meeting both times was conducted in Lao, which is good because it means the Lao teachers are taking more responsibility for decision making and teaching. Since the ultimate goal is for the programs to be independent and sustainable without outside leadership or support, that is great. However, between two meetings mostly in Lao, rounding on the wards where presentations to me are in english, but communication with patients and colleagues is in Lao, and resident topic review and case presentation (which is in English on the screen but in Lao verbally) my ‘sincere’ active listening skills are getting a work out. The decision from the two teachers meetings was to go back to a monthly focus curriculum. This month is neurology month, so I’m preparing a talk on bacterial meningitis for this week.
I finally got some fruit. I succumbed and purchased at 17,000 kip mango at the Falang grocery store that is 1.5 blocks from home. That’s just over 2 dollars, which is what I would pay for a mango in Minnesota, but this was a giant, ripe, delicious mango, so I’ve reconciled it with myself. In fact, after the first one, I got a two pack the second time. They are yellow mangoes, more like the ataulfo mango sold at the coop than the orange ones I ate in Africa. I also tried pomello, which is like grapefruit but bigger, with bigger grains of fruit, and sweeter and milder. It is delicious, but somewhat hard to prepare. I also ate at “Nudle”, the new noodle take away that is 2-3 blocks from our house, and conveniently on the way home from the hospital after late lectures. Apparently, they have a giant noodle box costume that someone has been wearing to advertise the grand opening, though I have not been fortunate enough to witness this. Amy saw a smallish person manning the costume somewhat clumsily with a large British man tailing him/her and saying “take it slow. . .” last weekend. I am too hot in a skirt and t-shirt, so I don’t even want to think what it would be like inside a noodle box costume. But the noodles are good and the price is right ($2.25 for a box which is enough for at least 2 meals) so I anticipate I will become a regular, and one day will get to see the giant noodle box.
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