Lao Lao Liaw Laew

These four words mean: a person or thing in/from Laos, whiskey / alcohol, turn, and and then / already. I think I am understanding more Lao, but speaking is hard, and the more I learn, sometime the more confused I feel. Our teacher is very patient with us trying to figure out the differences between words that are clearly different to her.

I have had a visitor, Dr. Leila from Mung Sing, a former Health frontiers pediatrics co-ordinator who now lives in far northern Lao and helps children there. It has been interesting to hear all her stories of living in Lao for the past 7 years, but has also been time consuming, so I have not had much time to blog. (Or reflect on the last week and a half.) However, she has had some incredible experiences, particularly in looking for victims of Noma (a malnutrition / immune compromise related disease in which portions of the face of children essentially rot away - google image Noma if you have a strong stomach). They are located in the poorest areas of Lao (and therefore the hardest to get too. When Leila found the first victim, it was thought to be a disease which occurred only in Africa, though historically it had happened worldwide 200-300 years ago. She has now found 22 victims, and arranged for reconstructive surgery, which not only improves their appearance, but often restores their ability to eat solid foods communicate better, etc. Now she is traveling around the country again to follow up on the outcomes of the patients.

While Leila was away, I went to the COPE ( http://www.copelaos.org/ ) concert Saturday night. It was raining, but this didn’t really significantly diminish my enjoyment of the music, as it wasn’t cold. I saw two bands perform - a sort of Lao ska band who were quite good except when they allowed a female friend (girlfriend of a band member?) to sing with them - then we got a truly off rendition of “Knockin’ on Heaven’s Door.” The second band was “U Luv Us” - a band composed of foreigners who sing pop-esq ballads and faster songs in Lao. Their music is pretty good, and they are totally hilarious to watch with their faux hawks and heart shaped sunglasses and smoke machine. There were two Lao girls standing right behind us that kept screaming with glee when they started/ended a song etc, which only added to the experience. Luckily, no one fainted since we were outside in the rain and mud. Unfortunately, I was too short to get a good look at the hip-hop dancing troop that performed between the bands, but I think hip-hop dancing troops are quite similar world wide, so it’s probably ok. This suspicion was confirmed by the fact that one of them was wearing a Michael Jordan jersey. Dinner before hand was at the Taj Mahal - Lassi’s, samosas, nan, rice, daal, and chicken Korma for two, all for less than 9 dollars. Delicious!

COPE is a great organization that provides rehab, prosthetics, mobility devices, etc for victims of cluster bombs (Thanks, America!) and other disfiguring, disabling accidents. They also have a blind school and a deaf school on their campus. (There is no ADA here, so blind, deaf, or otherwise disabled children are often refused entry to schools.) They have a visitor center that has some information on cluster bombing and it’s prolonged consequences, as well as profiles of some of their successes. The conference to ban cluster bombs will be in Vientiane in November, which is appropriate as Laos is one of the most heavily bombed country in the world. Of course America has not yet ratified this ban. . . Anyone planning to visit me here in Vientiane can expect to visit the COPE visitor center as well.
Sunday I went to the Buddha park. The Buddha park is as statue park about 25 KM (or 45 -60 min) outside Vientiane, past the friendship bridge. It is filled with statues of Buddha and Hindu deities which were commissioned by a man who was out walking in the mountains when he fell through a sink hole landing in the lap of a Guru. This experience inspired him to make or commission giant concrete statues of Buddhist and Hindu deities, which were made by people who had no formal training in art or sculpting. In this context, the quality is actually surprisingly high. The statues are all packed pretty close to each other, which makes them hard to appreciate individually sometimes, but easier to see as a body of work and to think about the inter-relatedness of the myths etc. It was drizzling off an on, which hampered my enjoyment (and photographs) somewhat, but it was a nice way to spend an afternoon. On the way home I stopped and bought oranges and bananas at a local market all in Lao! My visitor from America arrived home from Vang Vieng Sunday evening, and I got to hear about his trip at dinner. Then Leila arrived from Khamua and Bolecomsai, where she was following up on Noma patients, and scarfed down some spaghetti (I’m not the only one that misses pasta!) and we walked home from downtown together.

On the work front, things are good. The “most talkative” (his own description) chief resident has returned from two months in Khon Kaen, Thailand, and the other 3rd year chief is away at Khon Kaen, so Phanivone has been ruling with an iron fist. Not really, but last weekend he called me at 7:40 AM on Sunday because the printer in the resident room was not working, and they wanted me to bring a new toner cartridge to the hospital. (I did not.) Turns out that the printing emergency was an organizational chart which assigns all the residents duties in teaching (eg: rheumatology, cardio, endocrine) and in more mundane tasks (budget, accounting, cleaning the resident room). The task and resident responsible were printed, and then they were all pasted to a poster-board, and once they add the resident’s pictures they will hang it. They love adding passport photos to things here - that makes it official. I will take a picture once they’ve got it complete. I don’t know if I’ll ever be able to tell whether people are doing their assigned job, or how the assignments were made (I suspect it was not a democratic process). The good news is, they were able to solve the toner emergency without me by shaking the ink cartridge. Phanivone has translated two or three of my lectures now and I can tell he is adding in things (because I’m hearing english medical words I didn’t say) but I suppose as long as they are accurate things, that’s ok. They seem to usually be things I was going to say later in a more detailed section of the talk. The residents are very patient with me - they do not complain when lecture goes over the 1.5 hr time, and even manage to still look interested and clap at the end. However, I must do better at limiting what I try to cover.

We had KKU grand rounds on Friday. The speaker was an Electrophysiological cardiologist trained at Duke. I remembered to check the gas tank this time, so there were no embarrassing trips to the gas station. The topic was update in the management of arrythmias, and I think it was better received in Thai than the recent french lectures on the same topic. In Lao, we do not have a cath lab, so there are no EP ablations (Or stenting for Acute MI, for that matter), but in Thailand they can do all of those things, and a pacemaker is only 1000$! (Though the Thai have socialized medicine, so they pay 1 dollar for each hospitalization) This doesn’t really help the Lao, because for most of them 1000$ might as well be a billion dollars - there’s an equal chance of them seeing that much money - but I think they are more likely to get cath labs, pacemakers, etc, if they keep hearing about it from their neighbors.

Excellencies, Ladies and Gentleman

Wow, it has been a busy week. Last night I went to a concert celebrating the 15th anniversary of the re-establishment of friendship between the Republic of Korea (South Korea) and Laos. In the introduction and concluding speeches, they addressed us as “Excellencies, Ladies and Gentleman.” I’m pretty sure that the excellencies were only the diplomats in attendance, but it was still funny. The concert was pretty cool. It was sponsored by a “Beautiful Mind” organization of South Korea which aims to promote friendship and peace through music, and to support disabled or underprivileged children in learning music. They played some classical music in the first half, then they had a pianist with cerebral palsy play after an inspirational video about his struggle to gain dexterity in his fingers. The second half was traditional Korean instruments, which was really cool. My favorite was the Haeguem, an upright stringed instrument played with a bow, because the woman playing it moved her shoulders and back when she moved the bow, so it almost looked like the instrument was playing her. They also had traditional drums, a long stringed instrument played with the fingers, and korean flute. For the finale, they played Edelweiss, a russian folk song, a korean folk song, and then a much loved Lao song about the Dok Champa (Frangipani flower) with the korean traditional instruments and piano, violin, and cello. Supposedly, there are only a few classical concerts each year in Vientiane, so I’m glad I made it to this one. Plus, it was inside the Lao cultural hall, which I hadn’t been inside yet, so that was an interesting bonus. Concert etiquette is very different here - people were arriving, leaving, and stepping out for phone calls throughout the concert, and they had the performers use microphones (which I don’t think they would have needed to do for a space that size) but it was free, so I really can’t complain. Afterward, we had dinner at as small Japanese restaurant, and then drinks at the Jazzy room, a bar up a small wooden staircase that had posters of famous American jazz musicians hanging.

On Thursday, my first visitor arrived. Dr. S is an internist doing primary care in America, who has come to volunteer and teach for 3.5 weeks. He originally trained in Hong Kong, but has been practicing in the resource-rich setting of American medicine for the past 10+ years, and I think this is his first trip to the developing world, so he had quite a culture shock on rounds yesterday. For example, on Thursday I saw a patient with likely periodic hypokalemic paralysis (A very rare disorder of suddenly low potassium, often overnight, leading to muscle weakness.) On Thursday we had gotten his potassium lab back and it was 1.54, (ridiculously low, for my non-medical readers) so the residents planned to give oral and IV potassium and recheck the level. Friday morning. In America, this would be completely unacceptable, but here even if there is a lab tech who would run the lab at 4 or 5 PM after replacement, there is no doc to follow up on the result, as there is no formal cross-cover sign out. And his weakness was improved, so hopefully his potassium level was improved as well. Our visitor was shocked that the residents had not checked the level again, whereas having spent 2 months in Africa, once daily labs (at the most) are what I expected when I arrived here. (Bonus: I got to see real live U waves on EKG with this case, for the first time. Not small ones either. I have a copy of the EKG.)

Thursday I finally visited the temple with the little Buddhas. A monk who spoke a little english explained to me that the Stupa collapsed and they found all the little Buddhas. Since Stupas are filled with Buddhist relics or symbolic objects, I guess that finding the little Buddhas was not surprising. It is still pretty cool, though, because they are old. The little Buddhas had been placed on a table and baskets in the main temple which had been closed off, and a small altar set up in front of the table, where people are coming to make offerings of marigolds, incense, candles, and money. I will try to post pictures on Facebook. Thursday evening, at english class I was presented with a coconut pastry and a pineapple pastry for national teacher’s day. At my IM lecture (“GI anatomy”) I was presented with red wine and informed that not only was it national teachers day, but they wanted to keep my cholesterol low. I guess residents come up with the same excuses for drinking red wine worldwide. . . having used this to justify more than one glass of red wine over the past 3 years, I had to chuckle. Though I don’t think I ever combined red wine and a lecture in my day.

Now I am off the market to buy a couple more sin’s (Lao skirts) as I have been told that the residents will get bored of my first 4 soon. I have two medium blue, a purple, and a light blue now, all with horizontal stripes, so I think I’ll look for something pink or purple with vertical stripes.

Bor Pben Nyang

It has been a busy couple weeks here. And I have a cold. So I will apologize for not posting more frequently. Hopefully you, dear readers (Mom) will say “Bor Pben Yang” which literally means “no ask why” but is used to mean “no worries” or “it’s ok.”

Christine has gone home to Minneapolis after her trip to China. She got back to Lao Thursday afternoon and it was a whirlwind weekend of packing, saying good bye, and last minute information sharing. She was kind enough to lecture Thursday night on urinalysis and urine sediment while I got the microscopes set up. (They have recently returned from Bangkok where we sent them for cleaning.) Unfortunately, as I unwrapped them, I discovered that one was broken in transport, so we only have one working microscope right now. Frustrating, especially since Christine spent a lot of time in the last several months figuring out how to get them to bangkok and back safely. Thursday I also started feeling sick, and had a fever and myalgias by Thursday night, so it’s lucky Christine was planning to lecture. Friday night we had a going away dinner for Christine at “Moon the Night” a restaurant on the Mekong, and then went to a see a friend’s band “ULuvUs” play. The band is composed of all falang (foreigners) but sings songs in Lao (with some english phrases) and has quite a following of falang and Lao. Apparently, they have even made it fairly high on the charts in Thailand. Erwin, our friend, is Australian and plays the Keytar and keyboards. The music was pretty standard pop - but they had some good tunes and it was cool to hear them sing in Lao.

Saturday we had resident games as a going away event for Christine. We played soccer, did the limbo, played basketball, jumped rope, and finally had medicine vs pediatrics tug of war. Medicine won for the second year in a row, despite having Joey, our english teacher, anchoring their team. To be fair, they are mostly girls. I played soccer for the first time since elementary school, (which is to say quite badly) and the residents were all very kind and did not make fun of my lack of skills. We had a lot of fun, and it was good to be reminded of how much fun a group of adults can have with just a soccer ball, a mop, and a rope. Unfortunately, running around for 3 hours after being up late was not good for my cold, so I spent the afternoon in bed rather than watching the second Australian Grand Finals. Fortunately, Collingwood, Chris’s team, won by a large margin, so everyone in our group was happy with the day. Sunday we had a last breakfast and lunch at Kung’s (last for Christine) and I helped her pack her bike up. In the evening, we crammed a few last things into her 5 suitcases, weighed them. (I need to learn not to weigh my suitcases on bathroom scales. They are never accurate and just lead to more anxiety) Amy, Chris, and I drove her to the airport, where her total luggage weighed in at 133 kg (5 cases and a bike in a box) which is actually not a bad accumulation of stuff for the past 2 years, I think. Some of the residents met us at the airport with a bouquet of roses for a final good bye. It was sad to see her go, and I hope she is happy once she settles into her new job back in Minnesota.

I still have not made it to the temple near our house where the small Buddhas were found. But I have arranged lecturers for most of GI month (October) which took several visits to Mahosot last week. I will start with GI anatomy Thursday, and one of our fellows will teach GI bleeding tomorrow. Today’s lecture was cancelled because of a symposium by the IFMT (Institute Francophone Medicine Tropical) - I hear they have good teaching mostly in Lao at this, so that’s ok.

Today Tanja and I bought our tickets to Luang Prabang for the weekend before Halloween. We will ride the bus (8-9 hours on a “VIP” bus, with air conditioning) there on Friday, to see the country side, tourist on Saturday and Sunday, and fly home (1 hour) on Monday. I will take my zofran with me. Luan Prabang is one of the main tourist destinations in Laos - it is known for it’s old temples and scenic parading monks - and the weekend we are there will also be the end of “buddhist lent”, so they will be floating banana leaf boats down the river for good luck in the next year, too. We will miss the boat races in Vientiane, but I think we will be able to see more of the banana leaf boats, and it was the only weekend in October or November that I could take Friday and Monday for travel. So that’s something to look forward to, and I may soon have my multi-entry visa, so I can also think about a trip to Thailand.