On Saturday I flew to Phongsali. I had 38 kg of checked luggage - my 12 kg travel backpack (some of the weight was a pencil sharpener, and there was some heavy food.) Then there was a 25kg bag containing 1050 posters in 21 50 poster packets and 100 rolls of colorful paper for a project for the children, 100 pipe cleaners, 1 kg of coffee from Kungs for Bryan, a graduation present for a 2010 graduate, and some chocolate and cookies. I showed the people at the counter Leila's Noma poster and explained it was outreach for sick kids, and they let me ship the heavy bag for free. Lao Airlines is such a pleasure to fly; that would never happen in America. Anyway, I arrived in Udomxai and Leila met me at the airport. Leila is an American pediatrician who now lives and works in Northern Lao, is a former pediatrics coordinator, and helps HF with resident recruiting from rural hospitals.) I carried all 38 KG of luggage to the tuk tuk in one trip by myself! (Leila had my day pack and purse, and has osteoporosis, so I didn't want her doing any heavy lifting.) We went to the guesthouse where we stowed the luggage and then I had a late lunch of pumpkin soup and delicious fried niblets. We delivered 5 packets of posters to a man who works for an NGO in Udomxai and will try to get one to each district for distribution. We walked to a temple mentioned in the Lonely planet and saw a beautiful concrete tree of life sculpture. It rained on the walk back, but we were able to deliver a (slightly wet) Fitzpatrick's guide to dermatology to the 2010 graduate in Udomxai - I had missed seeing him at CME in the spring. Our work done, we found a new hotel recommended by Leila's friends and had a massage and then a late dinner.
Tree of life sculpture, Udomxai.
Saturday we took the bus to Phongsali. In good conditions, it takes 8 hours. We left at 8 AM and arrived at 8 PM. The first part of the road was paved. Then we got to dirt road - windy, muddy (it rained almost all night Saturday night) mountain dirt roads. Our bus driver was great - he didn't try to go too fast - and he had an assistant that sat next to him and helped choose the route. When it was particularly muddy or challenging, he hopped out and walked along giving advice from the front, then got back in when we were through the rough spot. There were some narrow, muddy areas, but I was never _really_ worried the bus would slide off the edge of the cliff. I was sometimes a little bit worried about that. We didn't stop for lunch until well after noon, and we stopped at a little roadside stand that sold chips and soda. Luckily, I had brought bread and cheese from Vientiane, so we didn't go hungry. All the Lao people had packed their own lunches too. Along the way, Leila gave posters to everyone getting off the bus to hang in their towns. The last 60 KM of road (we went between 200-300 km total) was paved, but still windy and it was dark by then, so it was still pretty slow going. We passed on the first guest house we saw and stayed at the second, where we were soon to discover the Lonely planet's description of plumbing problems was correct. We had eaten the second half of the Gouda on the bus, so we just went to bed. Riding the bus all day was somehow pretty exhausting.
Buying bracelets at a roadside bathroom stop.
Monday we had breakfast at the Yee Hua restaurant, where Leila discovered that the proprietor works for an NGO that goes to rural, hard to access districts in Phongsali (which as you can see from the above is already hard to access.) He agreed to distribute posters to many villages in 2 districts. Around 10 Am we finally got the go ahead from MOH to visit the hospital, and we headed out and met with the vice director. We gave him some pocket books and Lao-language Mahosot Microbiology Reviews, and got some information about the hospital. He invited us to come back the next morning at 8:30 for rounds. We walked back to the guest house and packed the peanut butter and a roll and headed up the Phou Faa - sky mountain - for a short hike. It ended up being at least 2 KM up the road (we could have taken 400 stairs, a more direct route, but they were pretty mossy and treacherous looking.) We ate lunch overlooking the city accompanied by several very friendly butterflies. Then Leila convinced me we should go to the viewpoint. We thought it was 30 Meters, but quickly realized the sign had meant 30 minutes. About an hour later, after traveling through thick jungle on an overgrown path we arrived at what was a really fabulous view point. Leila walked first to brush away the spider webs after we found a giant spider over the trail early on. We left the big ones alone and just snuck under their webs. At the viewpoint we had almost 360 degree views of the mountains of Phongsali stretching out away from town. I discovered the friendly brown creatures persistently climbig up my shoes were leaches, not caterpillars, as I had hoped. There was no way I was going back past the giant spider, so our only choice was to go down, through the jungle, on another small trail past the tea plantation. It started to rain on the way down, but I had my poncho. The tea plantation was just a porch full of women sorting green tea from giant incredibly heavy bags, and more women and men carrying the bags up the hill from the surrounding areas of tea bushes. Unfortunately, they weren't set up to let us taste or buy tea, so we just headed on, back around the mountain on the Hat Sa road, to the town. I managed to accost one last leach who had made it to just above my knee inside my capri pants, and scrape several more off my shoes. Leila discovered 3 or 4 that had climbed up her pants when we go home (I thought I saw spots of blood appearing on her jeans, but she didn't want to stop and check) - so while my freaking out seemed kind of silly, it did prevent me from being suckered. By this time it was late afternoon, so after a brief rest we went to a restaurant recommended by the Lonely planet, where we pointed to some vegetables we wanted on their display area, and two lovely stir fries were prepared for us.
Leila at the top of Phu Faa
On Tuesday we returned for rounds. I went with the person in charge of internal medicine - a 3 year trained doctor who went to school in Vietnam. We saw 7 patients, 5 of whom were women with abdominal pain, one man with shortness of breath, and an 8 month pregnant woman who had flank pain and fever that had not improved after 8 days of Ampicillin. I called Leila in to help translate and we talked about urosepsis in pregnant woman and advised they switch to gentamyacin and ceftriaxone, then Leila gave the doctor another copy of the Lao Language MMR with sepsis guidelines. We were done rounding, so I joined Leila in the well child clinic (they had no pediatric inpatients) where she had spent the morning encouraging them to weight the children and found that all of them were underweight, and then counseling the parents about good nutrition. As we were leaving we were invited to come back for the afternoon. So after lunch we returned and spent another half an hour in well child clinic. Then a member of the hospital staff came and told us they were ready for our teaching. We hadn't prepared any teaching. Yikes! Leila talked for 30-45 minutes about weighing children and good nutrition and then for another 15-30 minutes about fever in Laos with some input from me. Leila can lecture in Lao and they understood her, especially with the help of a surgeon sitting at the front of the room who did some extra explaining. Then they said that was great, but they were ready for the adult teaching. So I talked for 15-30 minutes about prevention - I did some speaking in Lao but mostly Leila translated for me. We talked about exercise, healthy diet, not drinking a lot, and not smoking and how these four interventions could decrease diabetes, stroke, heart failure, heart attacks, and liver disease. They agreed that Lao people don't like to take medications every day and so prevention was important, and seemed engaged in my teaching as well. We took a group photo and the day was over at 4 o'clock. Leila was pretty exhausted, so she went to bed almost immediately and I had a snackish dinner.
Doctors, nurses, pharmacists who attended our impromptu teaching in Phongsali.
Wednesday we took the bus from Phongsali 22 km to Hat Sa over a very muddy, under construction dirt road. We had 2 stops - once for a digger truck that was pushing landslide dirt off the road and making it passable - and the second to widen the road where the outside edge had collapsed. The bus driver and some passengers pushed some rocks from the uphill side over the edge so the road was just wide enough for the bus to cross the narrow area. All the passengers got back in once he was across. At Hat Sa, we got in a long boat. We rode down the (very full) river for 4 hours to Meuang Kheua, arriving in mid afternoon. We passed beautiful mountains and saw some lovely birds, and our driver skillfully guided us through the rapids. The guesthouse recommended by lonely planet was full, so we checked into one two doors down which was basic but had fully functional bathroom plumbing. We relaxed for about an hour before wandering around town a bit and then getting dinner at a restaurant overlooking the river and river crossing ferry landing. the sunset was behind us, but it was still a beautiful place to have an early dinner and watch the activities on the river. And the mushrooms with ginger were quite tasty.
View from the long boat.
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