Pbai Saa Saa

The longer you go without blogging, the harder it is to restart, because prioritizing what to write about gets harder as more events accumulate. . . So I’m going to just start at some random middle spot and write about a few things.

Jon and Rose, the doctors from Regions hospital who ‘recruited’ me to be the HF residency coordinator are visiting Lao for 2 weeks. This has been fun for many reasons - they brought me some silver sulfadiazine for my burn and several tubes of Neutrogena sunscreen and moisturizer from home (the only thing I haven’t found here as far as cosmetics go - it’s hard to find moisturizer without whitening agents, which I don’t want and am pretty sure my dermatologist would not approve of.) They also brought me a gold Buddha poster from Luang Prabang - I had wanted to buy one but we missed the second night of the night market because we were busy sending our sins down the river. And they buy me dinner every night as a way to “support my volunteerism.” But most importantly, they give me good perspective about how things have changed (mostly for the better) or not changed (again, mostly for the better.) And after a few months here by myself, it’s nice to have some other people familiar with the systems of internal medicine to bounce things off. I know I could do this by e-mail any time if I had a big question, but for 2 weeks I can bring up small questions that might not be worth writing an e-mail about. Plus, there’s something that’s just different about discussing things in person - there are nuances that can’t be conveyed by e-mail. So one week into their visit, I am very happy to have them here.

I had several challenging patients last week - a woman younger than me with Acute Myeloid Leukemia M5 (A disease which is fatal more than 50% of the time in America) who had gone to Thailand and had several rounds of chemotherapy, survived at least one episode of neutropenic sepsis in Thailand, and been sent home after her last round of chemo. She relapsed and came in to the Lao hospital with GI bleeding, low platelets, and fever, with a high enough white blood cell to be sure her leukemia was back. (Which was the far most likely outcome after chemo, so not surprising.) She didn’t have enough money to go back to Thailand, so died at Setta of “cardio-pulmonary arrest” overnight one night. It’s always hard to see someone younger than you that you know is going to die (or has died) but it’s even harder when you also know that family just spent their life savings on chemo for a disease that is hard to cure even with bone marrow transplant, and to cure it with chemo alone would be almost a miracle. I don’t know what kind of informed consent is possible given the immense difference in education and the fact that Thai and Lao are similar, but not the same language, but I feel like it probably wasn’t enough. I think if you told most 27 year olds here that they could get chemo but still had a 90+ percent chance of dying, and it would deplete their family’s life savings, they would go home to spend their remaining days with their family, because there is a much more acute awareness here of the value of even a little money to make many people’s lives better.

On a happier note, yesterday I went to the Nam Ngum Dam with some lovely Swiss-Germans. Tanja invited me, I think as a sort of thank you for looking after her for a few days 2 weeks ago while she had Dengue. (Which I really hope not to get, after watching her have it.) It was beautiful - much larger than I expected. On the way there we stopped at a salt factory, which was really interesting. Then we drove on to the dam, which looked small from the bottom, but had a giant reservoir behind it, and supplies most of the power to Lao, plus exports a lot of hydroelectric power to Thailand. We had lunch on a restaurant overlooking the water - delicious lake fish - and then took a short boat ride in a giant, noisy boat before the minivan ride home. I didn’t get to swim, and the water wasn’t the clearest, but I think if you set out a bit earlier you could do some pretty cool hiking or boating with lunch on an island.