On Friday morning, I was reluctantly struggling to motivate myself to wake up up and get out of bed when I realized with alarm that the local NPR station was reporting about some kind of mass shooting in Aurora. I was immediately awake, feeling dread, discouraged and disgusted. But not surprised, which says something about me and a lot about the society in which I live.
The last time I was surprised by a mass shooting was April 20th of 1999. I was sent home early from school because of the news coming from Columbine High School in nearby Littleton. It happens to have also been my 18th birthday, and an alarming and distressing welcome to an American adulthood in which we would quickly become all too used to news of senseless gun violence with multiple casualties. Over the next few weeks the Denver community processed this news through filters of varying utility. (More effective: questions about bullying, mental illness, and police response times. Less effective: If you were in high school in Denver at that time, you’ll remember discussions of the “trench coat Mafia” and increasingly broad bans on school attire. In addition to outwear, Marilyn Manson, KMFDM and video games were quickly blamed.) And over the following year, a picture of disturbed, confused, hateful and hated young men would emerge. As a sensitive young person living near this tragedy, it took me months, if not years, to quietly process this event, and it is probably one of a few defining moments of my transition from child to adult. And as a child for whom bullying (or at least name calling) was not a rare event, and who lived on the fringes of a variety of social circles in middle and high school, I am proud and confident in the statement that I will NEVER understand how one’s self-hate, hatred of peers, and isolation gets so bad that mass murder even becomes an option.
I’m a realist, so I can honestly say that none of the subsequent mass shootings that have happened, mostly in America, has shocked me. I feel distressed, disgusted, and (mostly) discouraged, but not surprised. We live in a society where we have easy access to massively lethal weapons, often legally. And we live in a society that is polarized (perhaps increasingly, and many would argue intentionally,) and in which it is easy to become isolated, either by one’s own desire or unintentionally.
These are ultimately desperate, hateful acts. I truly believe, based on my witness of day-to-day life, that love is overwhelmingly more prevalent than hate, even in our modern, individualistic society. However, I think hate is disproportionately more visible. Our media to often focuses on hate, primarily to scare us into continuing to pay attention do them. Whether it’s individual hateful acts - murder, gang violence, domestic violence, etc - or groups of people who hate others - particularly those not like them, hate and fear keep people watching or clicking links. I can clearly see the hatred in conservative pundits anti-gay rhetoric, and it’s not far below the surface in pro-wealthy and anti-health care reform rhetoric either. But liberal news sites - those I go to for my news more often than not - also plant, tend, and harvest divisive news stories. Rhetoric of fear and hatred.
I am lucky that I live in a world where the overwhelming prevalence of love is blatantly obvious to me. In Laos, though I sometimes felt socially isolated, I felt the love of my friends and family from back home supporting me. And every day I went to work I saw my residents and the Lao teachers sacrificing in order to learn and perform better patient care, which is a tremendously loving act. When I traveled in Asia, I witnessed people who loved life and each other, and took joy in small daily pleasures, despite not having access to many things I would consider necessary for a tolerable existence.
When I came home, even though I was working nights and had minimal interactions with other doctors, I could see the love in the work of my colleagues and nurses. I may not believe that everything done for the patients at the U of M is in their ‘best’ interest, but I can say that the great majority of it is done out of a profound love for life, and desire to make it longer and better. And I had a great relationship with nearly all the nurses, because I understood that when they page in the middle of the night, they’re doing it out of concern and love for their patients, and usually out of a desire to take the best possible care of them.
In my new job, my colleagues come to work every day to take care of an often challenging group of patients. Coming to work every day to try and make the lives of older people better - people who may seem to have little to live for, and who may not always appreciate, or even understand your efforts - is an act of love. My new mentors keep up to date with the (insufficient) literature about geriatric patients _and_ remember minutia about their patient’s lives out of love, not because they’re well paid (by doctors standards, they’re not) or highly respected. They love the patients and the job.
And in my new / old city - Denver - coming home after 12 years away - I feel incredibly welcomed and loved. I’m still at home in my church, Montview Presbyterian, which has an incredibly loving, inclusive approach to Christianity. I’ve reconnected with a couple old friends, and can still feel their loving welcome even though none of us has been great at keeping track of each other in the interim. The people in my parent’s apartment building are almost always happy to see me and ask how my new job and life transition are going. The fact that these people know who I am even though I’ve never lived in Denver since my parents moved there is a reflection of my family’s tremendous love. I could go on.
So, after 48 hours to reflect, a bacheolorette party celebrating love - romantic, sibling, and friendly- last night, a 45 minute drive with the Barenaked Ladies, and an excellent church service this morning, my thoughts on Friday’s mass shooting at an Aurora movie theater are becoming more clear. I don’t, like some conservative Christians, believe that god is punishing us for straying from our Judeo-Christian morals. I don’t believe that deity exists. But maybe we are punishing each other and ourselves for living in a place and time where we too often acknowledge and focus on the hate in our lives. We keep the love secret, private, and unacknowledged, though most of us probably feel it more often than not. So if you’re reading this blog, know that I love you and the role you play in my life. But more than that, know that I believe everyone who would be interested in reading these run on sentences lives a life that is motivated, powered, and protected by love.
Whether you recognize a religious source of your love for your fellow man, or are a secular humanist, I believe you all love far more frequently and deeply than you hate. In fact, I believe that none of you really hate, and even things you may say or do that express dislike of some aspect of our society (or personal lives) are motivated by love of some other principle or person. On this journey of life, I try to live my love - for myself, my family and friends, my fellow man/woman, and my planet and not hate or fear. Going forward, I will be trying to express this love more clearly - not just through my actions, but vocally, verbally. I am going to try to express my love to strangers - love I feel but may be reluctant to show - more openly and specifically. Maybe if Friday’s shooter had felt, heard, or seen more of the generalized love that I am sure was present and active in his life he wouldn’t have committed his horrific act. (And less of the non-specific hate/fear that permeates our media but not, I believe, our culture.) We may never know, but on the other hand, being more open and direct with our love can hardly hurt.
I will also be lovingly making a donation to the pro-gun control lobby, because realistically, while a deep hatred of himself and those around him (and probably a significant mental health problem) likely motivated the shooter, what clearly made his actions so horrifically effective was the extremely deadly weapons he legally purchased. I’d like to live in a society where access to semi-automatic weapons WAS surprising.
lovingly,
Libby
Monday, July 23, 2012
Friday, February 10, 2012
Home Again, Home Again.
I’ve been home in the USA for 2 months now. I’ve been surprised by how little culture shock I’ve experienced. Maybe I’m just good at changing my expectations when I change contexts, or maybe I never fully adjusted to Laos. Or maybe coming home is always coming home and therefore positive, even if you’re coming from a very different place. I know I’m lucky that both Denver and Minneapolis feel like home now. It’s been nice to re-integrate relatively smoothly, but sometimes not feeling shocked to be home makes me wonder whether my experiences in Laos were ‘real’ or ‘valid.’ I spent the last 3 months I was in Asia traveling a good portion of the time - I left Vientiane September 17th and wasn’t back for more than a week until the last two weeks, which were a whirlwind of visitors. Since I don’t really have a full time home now, maybe I’m just still in travel mode, and when I settle down in June the culture shock will really hit.
The one thing that does consistently surprise and alarm me is how fast everyone drives. It took me a while to adjust to traffic in Vientiane - I blogged about it, and probably complained to many of my readers. But I definitely totally adjusted, especially to the speed. It is true that there are few true rules of the road in Laos - Christine, my predecessor was pretty accurate when she said the rules were “you’re responsible for what’s in front of you, what’s behind you is responsible for themselves, and don’t hit anything.” But everything happens at such low speeds that there is almost always time to react to whatever craziness is happening around you, and if there isn’t, the speed at which you collide with something/someone will be so low that the damage is minimal. American drivers have rules - lanes, stoplights that are observed, no right turn signs. (Free right turn, I miss you, even though I thought you were crazy when we first met.) But we drive so FAST! Even with all our rules, it’s not possible that we can all anticipate and respond to some change in our driving environment in time. I’ve been in more serious near misses (2, both people who were going too fast and tried to merge into me when they needed to change lanes suddenly) in 2 months at home that I was in 16 months of Lao driving, and I’ve been rear ended once. That was a low speed accident, but totally avoidable if the young woman behind me had been paying closer attention, going slower, and generally being more patient. Patience is something that has changed for me a lot in the last 3 years, and something I appreciate a lot more now.
But not having a lot of culture shock doesn’t mean I don’t really miss things from Laos. I miss the pace of life. Not just the traffic was slow in Vientiane, but just life in general. Things rarely started right on time (But not nearly as late as Africa) but it wasn’t a big deal to just wait. In a culture where there are no true emergencies some things don’t get done - some sick patients die who _might_ be saved in America - and some things that are lower priority tasks don’t happen, or happen much later. But the rest of life is so much more enjoyable when there isn’t constant pressure to finish what you’re doing and the rest of a long list of tasks. My Lao colleagues worked hard to improve themselves, their situation, and the care their patients received. The staff doctors worked hard at their clinics in the evenings to support their families and improve their situations. The resident worked hard when they were at work, often with inadequate support, and routinely attended afternoon and evening lectures despite being post-call. But they also took time to enjoy life - work started at a reasonable hour (8 or 9), they sat down together for lunch for at least half and hour every day, and when they had days off they spent them with family relaxing. Generally, I would say that Lao people as a group are happier than Americans as a group, which isn’t what you’d predict based on GDP, life expectancy, etc. It’s not that Lao people don’t want to succeed - they want to be successful in work, financially, and respected, and most of the doctors I worked with also really wanted to help people. It’s just that that is balanced by an ability to be present and happy in the simple moments of everyday life that are enjoyable. They have an ability to appreciate the intangible benefits of not rushing to get things done as well as the tangible benefits of getting things done.
I am doing my best to remain aware of this difference and make my approach to daily life as Lao as I can on my return. It’s not easy to be relaxed when everyone around you seems to be in a hurry. (See paragraph 2) And sometimes, very rarely, things do actually need to be done NOW. But when I find myself getting impatient or annoyed, I try to actively remind myself that the few seconds or minutes more I spend waiting for something, driving slowly, letting people merge at the last minute, aren’t seconds or minutes that I needed for something else. (Right now, my schedule is pretty flexible, I imagine this will be harder as I start working a 40-50 hour week again.) I try to remind myself that no one else cares that I may be in a hurry, so the only one that being annoyed really affects is me, and that effect is almost entirely negative. Generally, I’ve been doing pretty well at not being stressed out or annoyed by minor delays or hiccoughs that would have bothered me as a resident. (My time was much more precious then, though.) I’ll still call the nurse if the 1AM hemoglobin hasn’t even been drawn at 2, but I believe my tone is different when I ask why this is the case and how we can get things done. And I know, now more than ever, that if a minor delay in care is going to seriously harm a patient, that patient was probably in pretty big trouble already. I think many of my colleagues here would enjoy work a lot more if they could could appreciate this reality - many of the delays and errors that frustrate American doctors are things that are going to make no difference in the grand scheme. There’s clearly a happy medium of care delivery stress - Lao being too low, and America being too high - that would be a good thing to strive for.
Finally, I miss the sense of involvement and caring I had from my residents and colleagues in Laos. In Lao, someone, often a casual acquaintance, told me I was looking beautiful several times a week, and sometimes several times a day. Even going through the market, strangers would say how beautiful I was in my sin. It was weird to me - what is the appropriate response? You too? Thank you? I wasn’t used to people paying that much attention to me - my presence - unless they were close friends. In America we say “Hello, how are you?” but no one, even people you may work with on a daily basis, actually cares or expects an honest answer. In Laos, I felt like people genuinely cared. Another example - When I was traveling alone, especially in Thailand and Vietnam, people would ask me directly and early in our interaction if I was traveling alone, with a tone that I though implied both curiosity and some judgment. In Laos, people are shyer, so it would take a bit longer and the question was less direct, but it was still often asked. I perceived these questions a somewhat intrusive. Now I miss having interactions with someone who is that interested in my life (who isn’t a close friend or family member). I think saying “You’re beautiful” to a woman in Lao is sort of a way of saying that you acknowledge and appreciate your presence, they _see_ you are here. The same with asking if I was alone - I wasn’t just another white tourist, I was an individual person, traveling alone, which is a bit of an anomaly, and they were curious about me. In America I am a doctor, a gym patron, a person in line at the store, an airline passenger, but not an individual person who is present in the lives of those I’m interacting with. (Again, except my close friends.) It’s a bit de-personalized, where I often felt things were too personal in Asia. A final example - I still have a good number (more than 5) of baci strings on each wrist - white string that has been tied around my wrists and clipped a medium length. In more than 20 shifts at the hospital - all at least 12 hours - only 1 person has asked me what they were. Of all the nurses, colleagues, patients, and family members who have seen me roll up my sleeves to wash my hands and noticed I had a bunch of clean but frayed, ratty strings tied around each wrist, many of whom must have been curious or worried, only one has asked. (Are they an infectious disease risk? I do shampoo them every time I shower, so I hope not.) Again, with the exception of relatively close friends. I guarantee you someone would have asked or commented about something similar - easily noticeable, distinctive - at least once a day in Asia. They’re almost certainly unprofessional, but they remind me that a bunch of really lovely people wanted me to have a safe journey home and a smooth transition back to American life (and they worked!) So I’m keeping them, at least until I get home from New Zealand.
Oh, yeah, I’m going to New Zealand next. Departing Feb 14th and returning March 16th. I’m not going to do any health-care related activities (or at least not planning to!) so I won’t be blogging much, but I will probably try to post some pictures and brief impressions. Gotta test out my iPhone blogger app. And when I’m back and not spending time planning a trip, I hope I’ll find time and motivation to write more about Laos as well.
The one thing that does consistently surprise and alarm me is how fast everyone drives. It took me a while to adjust to traffic in Vientiane - I blogged about it, and probably complained to many of my readers. But I definitely totally adjusted, especially to the speed. It is true that there are few true rules of the road in Laos - Christine, my predecessor was pretty accurate when she said the rules were “you’re responsible for what’s in front of you, what’s behind you is responsible for themselves, and don’t hit anything.” But everything happens at such low speeds that there is almost always time to react to whatever craziness is happening around you, and if there isn’t, the speed at which you collide with something/someone will be so low that the damage is minimal. American drivers have rules - lanes, stoplights that are observed, no right turn signs. (Free right turn, I miss you, even though I thought you were crazy when we first met.) But we drive so FAST! Even with all our rules, it’s not possible that we can all anticipate and respond to some change in our driving environment in time. I’ve been in more serious near misses (2, both people who were going too fast and tried to merge into me when they needed to change lanes suddenly) in 2 months at home that I was in 16 months of Lao driving, and I’ve been rear ended once. That was a low speed accident, but totally avoidable if the young woman behind me had been paying closer attention, going slower, and generally being more patient. Patience is something that has changed for me a lot in the last 3 years, and something I appreciate a lot more now.
But not having a lot of culture shock doesn’t mean I don’t really miss things from Laos. I miss the pace of life. Not just the traffic was slow in Vientiane, but just life in general. Things rarely started right on time (But not nearly as late as Africa) but it wasn’t a big deal to just wait. In a culture where there are no true emergencies some things don’t get done - some sick patients die who _might_ be saved in America - and some things that are lower priority tasks don’t happen, or happen much later. But the rest of life is so much more enjoyable when there isn’t constant pressure to finish what you’re doing and the rest of a long list of tasks. My Lao colleagues worked hard to improve themselves, their situation, and the care their patients received. The staff doctors worked hard at their clinics in the evenings to support their families and improve their situations. The resident worked hard when they were at work, often with inadequate support, and routinely attended afternoon and evening lectures despite being post-call. But they also took time to enjoy life - work started at a reasonable hour (8 or 9), they sat down together for lunch for at least half and hour every day, and when they had days off they spent them with family relaxing. Generally, I would say that Lao people as a group are happier than Americans as a group, which isn’t what you’d predict based on GDP, life expectancy, etc. It’s not that Lao people don’t want to succeed - they want to be successful in work, financially, and respected, and most of the doctors I worked with also really wanted to help people. It’s just that that is balanced by an ability to be present and happy in the simple moments of everyday life that are enjoyable. They have an ability to appreciate the intangible benefits of not rushing to get things done as well as the tangible benefits of getting things done.
I am doing my best to remain aware of this difference and make my approach to daily life as Lao as I can on my return. It’s not easy to be relaxed when everyone around you seems to be in a hurry. (See paragraph 2) And sometimes, very rarely, things do actually need to be done NOW. But when I find myself getting impatient or annoyed, I try to actively remind myself that the few seconds or minutes more I spend waiting for something, driving slowly, letting people merge at the last minute, aren’t seconds or minutes that I needed for something else. (Right now, my schedule is pretty flexible, I imagine this will be harder as I start working a 40-50 hour week again.) I try to remind myself that no one else cares that I may be in a hurry, so the only one that being annoyed really affects is me, and that effect is almost entirely negative. Generally, I’ve been doing pretty well at not being stressed out or annoyed by minor delays or hiccoughs that would have bothered me as a resident. (My time was much more precious then, though.) I’ll still call the nurse if the 1AM hemoglobin hasn’t even been drawn at 2, but I believe my tone is different when I ask why this is the case and how we can get things done. And I know, now more than ever, that if a minor delay in care is going to seriously harm a patient, that patient was probably in pretty big trouble already. I think many of my colleagues here would enjoy work a lot more if they could could appreciate this reality - many of the delays and errors that frustrate American doctors are things that are going to make no difference in the grand scheme. There’s clearly a happy medium of care delivery stress - Lao being too low, and America being too high - that would be a good thing to strive for.
Finally, I miss the sense of involvement and caring I had from my residents and colleagues in Laos. In Lao, someone, often a casual acquaintance, told me I was looking beautiful several times a week, and sometimes several times a day. Even going through the market, strangers would say how beautiful I was in my sin. It was weird to me - what is the appropriate response? You too? Thank you? I wasn’t used to people paying that much attention to me - my presence - unless they were close friends. In America we say “Hello, how are you?” but no one, even people you may work with on a daily basis, actually cares or expects an honest answer. In Laos, I felt like people genuinely cared. Another example - When I was traveling alone, especially in Thailand and Vietnam, people would ask me directly and early in our interaction if I was traveling alone, with a tone that I though implied both curiosity and some judgment. In Laos, people are shyer, so it would take a bit longer and the question was less direct, but it was still often asked. I perceived these questions a somewhat intrusive. Now I miss having interactions with someone who is that interested in my life (who isn’t a close friend or family member). I think saying “You’re beautiful” to a woman in Lao is sort of a way of saying that you acknowledge and appreciate your presence, they _see_ you are here. The same with asking if I was alone - I wasn’t just another white tourist, I was an individual person, traveling alone, which is a bit of an anomaly, and they were curious about me. In America I am a doctor, a gym patron, a person in line at the store, an airline passenger, but not an individual person who is present in the lives of those I’m interacting with. (Again, except my close friends.) It’s a bit de-personalized, where I often felt things were too personal in Asia. A final example - I still have a good number (more than 5) of baci strings on each wrist - white string that has been tied around my wrists and clipped a medium length. In more than 20 shifts at the hospital - all at least 12 hours - only 1 person has asked me what they were. Of all the nurses, colleagues, patients, and family members who have seen me roll up my sleeves to wash my hands and noticed I had a bunch of clean but frayed, ratty strings tied around each wrist, many of whom must have been curious or worried, only one has asked. (Are they an infectious disease risk? I do shampoo them every time I shower, so I hope not.) Again, with the exception of relatively close friends. I guarantee you someone would have asked or commented about something similar - easily noticeable, distinctive - at least once a day in Asia. They’re almost certainly unprofessional, but they remind me that a bunch of really lovely people wanted me to have a safe journey home and a smooth transition back to American life (and they worked!) So I’m keeping them, at least until I get home from New Zealand.
Oh, yeah, I’m going to New Zealand next. Departing Feb 14th and returning March 16th. I’m not going to do any health-care related activities (or at least not planning to!) so I won’t be blogging much, but I will probably try to post some pictures and brief impressions. Gotta test out my iPhone blogger app. And when I’m back and not spending time planning a trip, I hope I’ll find time and motivation to write more about Laos as well.
Sunday, December 4, 2011
Thank you speech
This evening Emily (My successor) and I were the guest of honor at a baci hosted by the IM residents and teachers to welcome Emily and wish me a safe journey home. I was expecting to be asked to make a speach, so I prepared this. However, only Dr. Som Ok, the former President of the University of Health Sciences and the current Vice Minister of Health for medical education and human resources was asked to speak (which is OK with me.) But I will post what I had written here.
I came to Laos because I wanted to live and work outside America, and I had good mentors (Dr. Rosemary and Dr. Jon) who said it was a very nice place to live and work.
When I arrived here almost 16 months ago, I knew very little about Lao people or about Laos. I knew Lao people gin khaw niaw, (eat sticky rice) love spicy food, and that Beer Lao was “the beer of the wholehearted people.” That was about all I knew.
I want to thank you all for truly being the wholehearted people. You have welcomed me with open arms and showed me what that phrase means.
Thank you, Teachers. You have listened politely to my suggestions, even when they may not have been good ideas. You have gently guided me in the right direction when I got too far astray. You have supported me and helped me get things done for the residents and patients. You have taken me seriously, and thought about my suggestions when we did not agree. I want to thank you for recognizing which areas I could help you in and letting me help. And I want to thank you for not changing things solely out of politeness when my ideas were not good.
Thank you, Residents. Thank you for welcoming me to your hospital rounds, your lectures, and free time in the resident room. Thank you for trying to understand my lectures when they were too complicated, and for politely listening when they were too simple. Thank you for staying when my lectures go past 7:30, which they almost always do. You have supported each other well in learning from someone who does not speak Lao, not only translating for each other but also explaining and making sure everyone understands.
Thank you for welcoming visitors with the same warmth you show me, even if sometimes they do clinical teaching or lectures that are hard to understand, or tell you to do things that are not currently possible in Lao. Thank you for teaching me about diseases I knew little about, like Melioidosis or typhus, and guiding me through culturally complex patient interactions. Thank you for taking extra time to learn from me – to present patients in English, make a differential diagnosis even when you already knew what the patient had, and discuss what to do next, even if you had a plan with your Lao teachers that would not change based on our discussion.
I am very proud and lucky to be part of an organization like Health Frontiers. It is amazing to see what a group of dedicated volunteers can do with a little bit of money, a lot of time, and willing colleagues and students. I have a new way to judge NGOs and international health projects. I will look not only at how much they spend, or how many people they help directly, but whether they help local people create independent, sustainable changes. Health Frontiers projects in Laos have been successful because we are working with you, not telling you what to do or doing it for you, and because we have been able to commit far more human resources tha money -21 years of volunteers now.
However, I am even more proud and truly humbled by how hard you all work, and how committed you are to improving yourselves and healthcare for Lao people. You are all very smart people, and there are surely easier jobs, less stressful jobs, and better-paid jobs you could do. But you are committed to the health of the Lao people. The teachers show this commitment – you spend extra time on clinical teaching, lectures, organization of the program, and mentorship, without any extra compensation. And the residents show this commitment – you leave your practice, private clinics, and sometimes your home and family, to come study. Being a student is not easy, especially as an adult. I am very proud that you all chose to become residents and improve your knowledge and skills. You all give so much to your patients, students, and studies, even when you may feel like you have little time or energy for yourselves.
I know that as I go home to new challenges, you will all continue to rise to the challenge of teaching and learning. I am confident that our decision to make the IM residency more independent of day-to-day teaching by Health Frontiers volunteers will not decrease the amount or quality of teaching you get. I hope the residents all continue to work hard and improve their knowledge and skills. Do not get distracted by all the changes around you, but stay focused on becoming great doctors for all the Lao people. I know the teachers will continue to work hard for you, and I hope they will continue to improve their mentorship, teaching skills, assessment and feedback as new resource become available. And I hope the Lao government, University of Health Sciences, and Ministry of Health will continue to support the residents, teachers, and hospitals more and better with equipment, access to tests and treatments, improvements to curriculum and teaching skills, and improvements in undergraduate medical education.
Lao is changing – I have seen it just in the short time I have been here. Many of the changes are improvements. But the Lao people, especially young people like our residents, need to be careful about what parts of Laos you allow to change. I hope the things I have come to love will not change: your openness, gentle politeness, kindness, and honesty. Your willingness to work hard when needed and your appreciation of rest and relaxation, and your love of the Lao country and culture. I will miss these things very much when I go home.
So in conclusion, thank you again for a wonderful year of learning and teaching. I wish you all the best of luck, good health in the coming years, good learning and strong teaching in the future, and much happiness in your personal lives and professional fulfillment. Being a good doctor is hard, but it is also one of the best jobs in the world, and we are all lucky to be able to work together in this wonderful profession.
Now all that's left is writing and giving a goodbye lecture on Tuesday, a few meetings with Emily, Hakon, and Karen, some last minute shopping if my weight allowance permits, and eating as many yellow mangos as possible before Wednesday.
I came to Laos because I wanted to live and work outside America, and I had good mentors (Dr. Rosemary and Dr. Jon) who said it was a very nice place to live and work.
When I arrived here almost 16 months ago, I knew very little about Lao people or about Laos. I knew Lao people gin khaw niaw, (eat sticky rice) love spicy food, and that Beer Lao was “the beer of the wholehearted people.” That was about all I knew.
I want to thank you all for truly being the wholehearted people. You have welcomed me with open arms and showed me what that phrase means.
Thank you, Teachers. You have listened politely to my suggestions, even when they may not have been good ideas. You have gently guided me in the right direction when I got too far astray. You have supported me and helped me get things done for the residents and patients. You have taken me seriously, and thought about my suggestions when we did not agree. I want to thank you for recognizing which areas I could help you in and letting me help. And I want to thank you for not changing things solely out of politeness when my ideas were not good.
Thank you, Residents. Thank you for welcoming me to your hospital rounds, your lectures, and free time in the resident room. Thank you for trying to understand my lectures when they were too complicated, and for politely listening when they were too simple. Thank you for staying when my lectures go past 7:30, which they almost always do. You have supported each other well in learning from someone who does not speak Lao, not only translating for each other but also explaining and making sure everyone understands.
Thank you for welcoming visitors with the same warmth you show me, even if sometimes they do clinical teaching or lectures that are hard to understand, or tell you to do things that are not currently possible in Lao. Thank you for teaching me about diseases I knew little about, like Melioidosis or typhus, and guiding me through culturally complex patient interactions. Thank you for taking extra time to learn from me – to present patients in English, make a differential diagnosis even when you already knew what the patient had, and discuss what to do next, even if you had a plan with your Lao teachers that would not change based on our discussion.
I am very proud and lucky to be part of an organization like Health Frontiers. It is amazing to see what a group of dedicated volunteers can do with a little bit of money, a lot of time, and willing colleagues and students. I have a new way to judge NGOs and international health projects. I will look not only at how much they spend, or how many people they help directly, but whether they help local people create independent, sustainable changes. Health Frontiers projects in Laos have been successful because we are working with you, not telling you what to do or doing it for you, and because we have been able to commit far more human resources tha money -21 years of volunteers now.
However, I am even more proud and truly humbled by how hard you all work, and how committed you are to improving yourselves and healthcare for Lao people. You are all very smart people, and there are surely easier jobs, less stressful jobs, and better-paid jobs you could do. But you are committed to the health of the Lao people. The teachers show this commitment – you spend extra time on clinical teaching, lectures, organization of the program, and mentorship, without any extra compensation. And the residents show this commitment – you leave your practice, private clinics, and sometimes your home and family, to come study. Being a student is not easy, especially as an adult. I am very proud that you all chose to become residents and improve your knowledge and skills. You all give so much to your patients, students, and studies, even when you may feel like you have little time or energy for yourselves.
I know that as I go home to new challenges, you will all continue to rise to the challenge of teaching and learning. I am confident that our decision to make the IM residency more independent of day-to-day teaching by Health Frontiers volunteers will not decrease the amount or quality of teaching you get. I hope the residents all continue to work hard and improve their knowledge and skills. Do not get distracted by all the changes around you, but stay focused on becoming great doctors for all the Lao people. I know the teachers will continue to work hard for you, and I hope they will continue to improve their mentorship, teaching skills, assessment and feedback as new resource become available. And I hope the Lao government, University of Health Sciences, and Ministry of Health will continue to support the residents, teachers, and hospitals more and better with equipment, access to tests and treatments, improvements to curriculum and teaching skills, and improvements in undergraduate medical education.
Lao is changing – I have seen it just in the short time I have been here. Many of the changes are improvements. But the Lao people, especially young people like our residents, need to be careful about what parts of Laos you allow to change. I hope the things I have come to love will not change: your openness, gentle politeness, kindness, and honesty. Your willingness to work hard when needed and your appreciation of rest and relaxation, and your love of the Lao country and culture. I will miss these things very much when I go home.
So in conclusion, thank you again for a wonderful year of learning and teaching. I wish you all the best of luck, good health in the coming years, good learning and strong teaching in the future, and much happiness in your personal lives and professional fulfillment. Being a good doctor is hard, but it is also one of the best jobs in the world, and we are all lucky to be able to work together in this wonderful profession.
Now all that's left is writing and giving a goodbye lecture on Tuesday, a few meetings with Emily, Hakon, and Karen, some last minute shopping if my weight allowance permits, and eating as many yellow mangos as possible before Wednesday.
Friday, December 2, 2011
Letter to the Editor
I always write way to much for any letter to the editor to be published. So in addition to sending this to High Country News I'm posting it here:
Dear HCN,
I’ve been reading back issues of HCN while living and working in Vientiane, Laos for the past year. As a native Coloradan, outdoor enthusiast, and anti-corporate child of hippies, I tend to oppose commercial development of public lands and resources – mining, drilling, etc - pretty categorically. However, on a small point, I found myself agreeing with the mining representative in November 22, 2010’s cover story on mining “Hard Rock Showdown.” Mr. Cornoyer stated that mining in Arizona would be better for the planet than copper mining in Chile or the Congo. When Westerners oppose these projects, we need to ask ourselves where the resources that are not being mined in our states are going to come from, and where they are going to go.
Laos is a beautiful and very mountainous country; filled with steep limestone mountains that are absolutely overgrown by tropical greenery. In size, it’s about 90% as big as Colorado, but stretches out along the Mekong River. The mountains extend well into our neighbors, Vietnam and Cambodia as well. They are great sources of natural resources – both ores and as the substrate for rubber plantations, timber cutting, and other environmentally degrading but profitable ventures.
In Laos, mining, timber cutting, and rubber plantation planting are happening with little or no concern about environmental consequences, even inside national protected areas. I do not know if Lao law requires environmental impact statements, but I do know that bribing the right string of officials will give businessmen access to land, which will likely be completely unregulated or supervised, and there is unlikely to be any legal action for cleanup after the project and damage is done. Corruption is rampant in South East Asia – Laos ranks 154/187 for most corrupt nations on the latest survey from Transparency International. (With 187, Somalia, being the most corrupt) Cambodia is 164, and Vietnam 112. The US holds slot 24. Some of the companies working here are trying to teach the Lao people and government about environmentally responsible stewardship of their natural resources, but many see it simply as a poor country where a bribe here or there can get you access to very profitable natural resources.
So Mr. Cornoyer is sort of right, even though my natural tendency is to assume he is wrong. When we westerners absolutely refuse to allow our own natural resources to be accessed, it likely means that the copper for those hybrid cars, photovoltaic panels and other electronic gadgets we love is coming from somewhere else on our small planet; probably somewhere with much less oversight. (43% of copper comes from Asia according to this site: http://www.lme.com/copper_industryusage.asp, but I’m pretty sure Asia isn’t yet consuming that percentage of electronic gadgets, hybrid cars, etc.) We may not see the unpleasant tailings piles, nor will our water, grazing land, etc be harmed, but if there is a demand for that copper, it will be mined somewhere. And the people affected may be subsistence farmers in the developing world who have neither the time, knowledge and experience to resist development, nor the political clout or legal framework to limit impacts. When we take a NIMBY attitude to resource use in the west, we may really be hurting poor and powerless people in other parts of the world much more than the corporations we think we are obstructing. And that’s not responsible citizenship any more than allowing unrestricted development of our own natural spaces would be.
Thanks for keeping me connected to the west over the past year. Keep up the great work!
Dear HCN,
I’ve been reading back issues of HCN while living and working in Vientiane, Laos for the past year. As a native Coloradan, outdoor enthusiast, and anti-corporate child of hippies, I tend to oppose commercial development of public lands and resources – mining, drilling, etc - pretty categorically. However, on a small point, I found myself agreeing with the mining representative in November 22, 2010’s cover story on mining “Hard Rock Showdown.” Mr. Cornoyer stated that mining in Arizona would be better for the planet than copper mining in Chile or the Congo. When Westerners oppose these projects, we need to ask ourselves where the resources that are not being mined in our states are going to come from, and where they are going to go.
Laos is a beautiful and very mountainous country; filled with steep limestone mountains that are absolutely overgrown by tropical greenery. In size, it’s about 90% as big as Colorado, but stretches out along the Mekong River. The mountains extend well into our neighbors, Vietnam and Cambodia as well. They are great sources of natural resources – both ores and as the substrate for rubber plantations, timber cutting, and other environmentally degrading but profitable ventures.
In Laos, mining, timber cutting, and rubber plantation planting are happening with little or no concern about environmental consequences, even inside national protected areas. I do not know if Lao law requires environmental impact statements, but I do know that bribing the right string of officials will give businessmen access to land, which will likely be completely unregulated or supervised, and there is unlikely to be any legal action for cleanup after the project and damage is done. Corruption is rampant in South East Asia – Laos ranks 154/187 for most corrupt nations on the latest survey from Transparency International. (With 187, Somalia, being the most corrupt) Cambodia is 164, and Vietnam 112. The US holds slot 24. Some of the companies working here are trying to teach the Lao people and government about environmentally responsible stewardship of their natural resources, but many see it simply as a poor country where a bribe here or there can get you access to very profitable natural resources.
So Mr. Cornoyer is sort of right, even though my natural tendency is to assume he is wrong. When we westerners absolutely refuse to allow our own natural resources to be accessed, it likely means that the copper for those hybrid cars, photovoltaic panels and other electronic gadgets we love is coming from somewhere else on our small planet; probably somewhere with much less oversight. (43% of copper comes from Asia according to this site: http://www.lme.com/copper_industryusage.asp, but I’m pretty sure Asia isn’t yet consuming that percentage of electronic gadgets, hybrid cars, etc.) We may not see the unpleasant tailings piles, nor will our water, grazing land, etc be harmed, but if there is a demand for that copper, it will be mined somewhere. And the people affected may be subsistence farmers in the developing world who have neither the time, knowledge and experience to resist development, nor the political clout or legal framework to limit impacts. When we take a NIMBY attitude to resource use in the west, we may really be hurting poor and powerless people in other parts of the world much more than the corporations we think we are obstructing. And that’s not responsible citizenship any more than allowing unrestricted development of our own natural spaces would be.
Thanks for keeping me connected to the west over the past year. Keep up the great work!
Friday, October 21, 2011
On the Road – Brief Impressions.
The next 2 weeks of my trip in brief tidbits:
September 22 – Muang Khua hospital. No 6 year doctors seeing patients, but good facilities and equipment, and polite and engaged staff (3 year doctors and nurses) providing patient care. We didn’t round with them. If they had a pediatrician and an Internist (Ok, and a surgeon and OB) they could be a great small hospital.
September 23 – Travel to Muang Sing – Muang Khua to Udomxai (3 hours), Udomxai to Luang Nam Tha (3 hours) both on lovely roads. Luang Nam Tha to Muang Sing – 3 hours, longer than usual due to several large mud slides on the road. Arrived in Muang sing to Bryan and a crowd of 10-20 Lao children who were super happy to see Leila and shy to meet me. Dinner on their lovely balcony overlooking the army barracks, road, and countryside while the sun set.
September 24 – Market trip and butterfly children’s center in the morning – great to see Leila and Bryan in their element. Bike ride in the afternoon, then made spaghetti sauce from scratch to eat with rice noodles and Chinese cabernet (terrible!) for dinner.
September 25 – Mitchell Montessori Cinco De Mayo paper flowers at the childrens center. Bike ride to Koma’s Akha village in the afternoon – 6 KM up hill and lovely views on the return. Purchasing of large amounts of beautifully woven local handicrafts at a private market put on by local girls in Leila and Bryan’s house in the evening.
September 26 – Bike ride in the morning, children’s center for jump rope and puzzle games in the afternoon.
September 27 – One more walk through the weaving village and a few more purchases in the early afternoon, Last evening at the children’s center.
September 28th – up early and packed 4-5 kilos of new belongings tightly into my travel pack. Minibus to Luang Nam Tha where I rounded with 2010 graduate Veokham, who appears to be doing a fabulous job on his ward. Like recent residency graduates worldwide, he complained that we had not taught him enough musculoskeletal diagnosis and treatment – but he had managed to (accurately, I think) diagnose a patient with spinal chord stenosis anyway. Bike ride in the afternoon during which I took a wrong turn and ended up riding more than 20 KM, much of it on village trails. Luang Nam Tha valley is beautiful with rice fields and mountains, and the last leg was with beautiful late-afternoon lighting (but home before dark despite my miscalcuation.)
September 29th – attended teaching by Dr. Veokham to hospital staff in the morning – Dengue fever with all slides in Lao language! Wow! Gave the staff in the blood bank some excitement by donating blood – several cell phone camera photos were taken to document the occasion. Said a sad goodbye to Leila after lunch and had a relaxed afternoon.
September 30th and October 1st – travel to Mae Sot – LNT to Bokeo, across the Mekong into Thailand, and on to Chiang Rai the first day. Chiang Ria – splurged on Pizza and Salad after 2 weeks of not enough wheat or cheese. Chiang Rai seems like a nice little town. The next day, Chiang Rai -> Chiang Mai (bus station only) where 7-11 provided a safe but unappetizing lunch during my 2 hour layover, then on to Mae Sot. Thai buses and roads are much nicer than Lao, - there are assigned seats and I bought my ticket relatively early! But the movie on the first bus was so disturbingly violent I literally had to keep my eyes shut for much of the first 2 hours. Too bad,t the golden triangle has beautiful karsts. Arrived just in time for dinner with Cindy’s friends, delicious Thai food.
October 2 – Sunday in Mae Sot, a town on the Thai – Myanmar border. Brunch! at a Canadian run diner and a bike ride to the border, where even more beautiful textiles were purchased. The border has been closed for over a year, so no temptation to go across for a day.
October 3 – Got to see the clinic of Dr. Cindy – former HF IM coordinator, Med-Peds doctor, and now doing research and clinical care in very resource limited settings for Burmese migrant workers. Very impressed with the level of care, but more so with the training, skill, and motivation of clinic workers, most of who have less than a high school education, and are themselves ‘undocumented’ workers. Amazing work Cindy and her team are doing!
October 4 – Mailed 6 kg of textiles home to the US from Mae Sot, took the early afternoon bus to Sukothai, where I splurged on a hotel with a pool. Sukothai was in the process of flooding, so I would have gotten wet anyway, but the pool was a much nicer way to do it.
October 5 – trip to Old Sukothai and viewing of the ruins of an early Thai capitol city. Travel through flooding New Sukothai is probably what I will remember most about this day – flood waters are very mobile, and seem almost malicious. (I suppose I had always imagined them as static or slowly rising, not rushing and flowing, or rising quickly after spilling over something. Now I know.) People of New Sukothai for the most part going about their business and children playing in the wakes created by trucks passing through higher (2-3 foot) water areas. Lazy and not wanting to get my feet dirty again after the pool, ate a nice dinner at the hotel.
October 6 – Bus to Chiang Mai, hotelier kind enough to take me to the bus station in his truck, so I remain dry despite worsening flooding in the city and surrounding areas. My friend Ken arrives to find the hotel has cancelled our reservation and finds a nice replacement hotel (with pool!) Swimming, fruit shakes, pancakes, and an evening jaunt around Chaing Mai. Ken is MUCH slower at the night market than I am – isn’t that backwards? I must remember he’s seeing much of this for the first time, while I’ve been in Asian tourist market situations for a year now. Also, he’s pretty sleep deprived by now after an overnight bus.
September 22 – Muang Khua hospital. No 6 year doctors seeing patients, but good facilities and equipment, and polite and engaged staff (3 year doctors and nurses) providing patient care. We didn’t round with them. If they had a pediatrician and an Internist (Ok, and a surgeon and OB) they could be a great small hospital.
September 23 – Travel to Muang Sing – Muang Khua to Udomxai (3 hours), Udomxai to Luang Nam Tha (3 hours) both on lovely roads. Luang Nam Tha to Muang Sing – 3 hours, longer than usual due to several large mud slides on the road. Arrived in Muang sing to Bryan and a crowd of 10-20 Lao children who were super happy to see Leila and shy to meet me. Dinner on their lovely balcony overlooking the army barracks, road, and countryside while the sun set.
September 24 – Market trip and butterfly children’s center in the morning – great to see Leila and Bryan in their element. Bike ride in the afternoon, then made spaghetti sauce from scratch to eat with rice noodles and Chinese cabernet (terrible!) for dinner.
September 25 – Mitchell Montessori Cinco De Mayo paper flowers at the childrens center. Bike ride to Koma’s Akha village in the afternoon – 6 KM up hill and lovely views on the return. Purchasing of large amounts of beautifully woven local handicrafts at a private market put on by local girls in Leila and Bryan’s house in the evening.
September 26 – Bike ride in the morning, children’s center for jump rope and puzzle games in the afternoon.
September 27 – One more walk through the weaving village and a few more purchases in the early afternoon, Last evening at the children’s center.
September 28th – up early and packed 4-5 kilos of new belongings tightly into my travel pack. Minibus to Luang Nam Tha where I rounded with 2010 graduate Veokham, who appears to be doing a fabulous job on his ward. Like recent residency graduates worldwide, he complained that we had not taught him enough musculoskeletal diagnosis and treatment – but he had managed to (accurately, I think) diagnose a patient with spinal chord stenosis anyway. Bike ride in the afternoon during which I took a wrong turn and ended up riding more than 20 KM, much of it on village trails. Luang Nam Tha valley is beautiful with rice fields and mountains, and the last leg was with beautiful late-afternoon lighting (but home before dark despite my miscalcuation.)
September 29th – attended teaching by Dr. Veokham to hospital staff in the morning – Dengue fever with all slides in Lao language! Wow! Gave the staff in the blood bank some excitement by donating blood – several cell phone camera photos were taken to document the occasion. Said a sad goodbye to Leila after lunch and had a relaxed afternoon.
September 30th and October 1st – travel to Mae Sot – LNT to Bokeo, across the Mekong into Thailand, and on to Chiang Rai the first day. Chiang Ria – splurged on Pizza and Salad after 2 weeks of not enough wheat or cheese. Chiang Rai seems like a nice little town. The next day, Chiang Rai -> Chiang Mai (bus station only) where 7-11 provided a safe but unappetizing lunch during my 2 hour layover, then on to Mae Sot. Thai buses and roads are much nicer than Lao, - there are assigned seats and I bought my ticket relatively early! But the movie on the first bus was so disturbingly violent I literally had to keep my eyes shut for much of the first 2 hours. Too bad,t the golden triangle has beautiful karsts. Arrived just in time for dinner with Cindy’s friends, delicious Thai food.
October 2 – Sunday in Mae Sot, a town on the Thai – Myanmar border. Brunch! at a Canadian run diner and a bike ride to the border, where even more beautiful textiles were purchased. The border has been closed for over a year, so no temptation to go across for a day.
October 3 – Got to see the clinic of Dr. Cindy – former HF IM coordinator, Med-Peds doctor, and now doing research and clinical care in very resource limited settings for Burmese migrant workers. Very impressed with the level of care, but more so with the training, skill, and motivation of clinic workers, most of who have less than a high school education, and are themselves ‘undocumented’ workers. Amazing work Cindy and her team are doing!
October 4 – Mailed 6 kg of textiles home to the US from Mae Sot, took the early afternoon bus to Sukothai, where I splurged on a hotel with a pool. Sukothai was in the process of flooding, so I would have gotten wet anyway, but the pool was a much nicer way to do it.
October 5 – trip to Old Sukothai and viewing of the ruins of an early Thai capitol city. Travel through flooding New Sukothai is probably what I will remember most about this day – flood waters are very mobile, and seem almost malicious. (I suppose I had always imagined them as static or slowly rising, not rushing and flowing, or rising quickly after spilling over something. Now I know.) People of New Sukothai for the most part going about their business and children playing in the wakes created by trucks passing through higher (2-3 foot) water areas. Lazy and not wanting to get my feet dirty again after the pool, ate a nice dinner at the hotel.
October 6 – Bus to Chiang Mai, hotelier kind enough to take me to the bus station in his truck, so I remain dry despite worsening flooding in the city and surrounding areas. My friend Ken arrives to find the hotel has cancelled our reservation and finds a nice replacement hotel (with pool!) Swimming, fruit shakes, pancakes, and an evening jaunt around Chaing Mai. Ken is MUCH slower at the night market than I am – isn’t that backwards? I must remember he’s seeing much of this for the first time, while I’ve been in Asian tourist market situations for a year now. Also, he’s pretty sleep deprived by now after an overnight bus.
Tuesday, September 27, 2011
On the Road
10 days ago I left Vientiane for a trip through Northern Lao. I spent the 48 hours before leaving dealing with a semi-crisis of resident failure on the final exam. (when 6/7 residents fail the test, is the problem the test or the residents?) And trying to convince myself I was ready to be away from home traveling for more than a month. I haven't been on the road for that long in a long time. There were a couple fairly sleepless nights. But I'm doing OK so far!
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.
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.
Monday, September 12, 2011
Rites of Passage?
Today I got my first traffic ticket - apparently I turned left at a no-left-turn intersection. Luckily for me Margot (visiting Pediatric ID fellow and former HF peds coordinator) was in the truck with me and helped me be calm. We followed the police officer to the police stand, where we gave him 70,000 kip. Unfortunately, they were all out of bills, so we were unable to get a receipt. (IE: he will split the money with his supervisor.) I am left just feeling lucky I haven’t gotten a ticket before now - I didn’t even see this no left turn sign (apparently it was on the right side of the road; to drive here one violates traffic rules on a pretty much daily basis, (or risk interrupting the flow of traffic and confusing the other drivers) so even if I had seen it, I don’t know if I would have followed it. I’m also glad that after this week, my need to drive the truck should be pretty minimal. The steering is still weird after a couple steering failures (at very low speed) this spring, and I think it’s just ready to retire. I wonder how it will feel to get into Gordon, my geo prism, in December after driving an extended cab Isuzu with a topper for a year - probably pretty weird. I suspect my transition back to American traffic patterns may be just as hard as, or even harder than, my transition to Lao driving was. We shall see. . .
Today Novalinh and I also fixed the phone at the office without any help! Yay independent women power! The phone in Novalinh’s office (in the downstairs of my house) has been working only sporadically for about the last month - sometimes not having a dial tone and then often hanging up on people mid-call. But the fax machine is still reliable. I bought a new phone in Thailand a week ago, but that didn’t fix the problem. So I’ve been thinking about next steps. We were about to give up and call the repair man when it occurred to me to actually open and check all the connections - if it was a wire problem it should never work, so it must be a connection problem, right? The phone line comes into the house and then is split to the fax machine in the living room, and one cord goes over to the office. I had jiggled the wires going in and out of the boxes early in the phone- not working period, but not actually opened them. (And of course I’d unplugged and re-plugged all available connections.) So we opened the one in the office which looked fine, and then the one in the living room where I discovered one of 6 wires had broken and become disconnected. So Novalinh and I fixed it - I showed her how to safely use scissors to strip the insulation - she wanted to use a kitchen knife and her thumb - and we wrapped it around the little terminal and screwed it back in (using my small Phillips head screwdriver from the multi-tool I bought at REI the day I left Denver.) And the phone is working now! So hopefully we saved a few tens of thousands of kip to have someone from the phone company come out. Maybe it’s silly to be proud of such a small accomplishment, but at home I don’t know if I would have solved the problem on my own - I would have asked an electrically inclined friend to take a look at it. Here, I’m probably the HF staff with the most electrical experience of anyone (thanks science fair projects!) and was able to use logic - though it took me long enough - and basic fix-it skills to do it on my own.
I’ve been in Laos for more than a year now. My one year anniversary of life in Laos passed quietly on August 22nd, while Brent (a friend from residency) and I were in Luang Prabang. I didn’t even realize it was an anniversary until the next weekend when my Dad pointed out that I had now been here for more than a year. And now I’m getting ready to come home - the last few weeks have been a whirlwind of planning for when I am no longer teaching (making sure the residents have teaching arranged), getting things ready for the new coordinator (Emily) who will arrive while I am out of town at the end of October, updating sign outs, and planning my travels between now and December, when I come home to Denver. On Saturday I fly to Udomxai and meet up with Leila, and then we’ll go on together to Pongsali - one of the far northern Lao provinces, and one of the hardest to get to. From there, Luang Nam Tha, Muang Sing, Huay Xai, Mae Sot Thailand, and meeting up with my MN friend Ken in Chiang Mai, from whence we will return to Lao and do some ecotourism in the north, and pass through Vientiane again in mid-October on our way to Vietnam. I’m going to be quite the nomad for the next few months. I’ve also been trying to meet with all the relevant teachers, administrators, etc to discuss plans for the next 3 months, help the ID ward get started writing a fellowship curriculum (because I’m an expert on curriculum development. . . um, not.) and make sure the office will continue to function in my absence. So things in sleepy Vientiane, in the Lao PDR (Please don’t rush) have actually been pretty busy for several weeks. We’ll see if everything gets done . . . and I’ll try to blog at least once more before I go off into the wilderness.
Oh yeah, yesterday was the 10th anniversary of 9/11. I managed to almost completely avoid the coverage of the anniversary, just as I managed to pretty much avoid the 24/7 news coverage 10 years ago (I was in Budapest, Hungary studying abroad in September 2001.) I have been lucky to be in a place where I choose how, when, and how much to access US news at both times. Maybe I’m insensitive, but other than New Yorkers and people who lost loved ones or friends in the towers and planes, I’m not sure putting a lot of emotional energy into this anniversary is useful. Rather than focusing on how we were victimized 10 years ago, shouldn’t we be worried about the problems our nation and the world are facing right now? Shouldn’t we be working on economic recovery, universal health care, and thinking about the 2 wars that we started in the aftermath of 9/11/01 and what in the heck we are going to do about them? I don’t want to deny that 9/11 had a huge impact on our nation, but I would like to see us looking forward and working towards peace, reconciliation, prosperity, and human rights rather than looking back fearfully and tearfully.
Today Novalinh and I also fixed the phone at the office without any help! Yay independent women power! The phone in Novalinh’s office (in the downstairs of my house) has been working only sporadically for about the last month - sometimes not having a dial tone and then often hanging up on people mid-call. But the fax machine is still reliable. I bought a new phone in Thailand a week ago, but that didn’t fix the problem. So I’ve been thinking about next steps. We were about to give up and call the repair man when it occurred to me to actually open and check all the connections - if it was a wire problem it should never work, so it must be a connection problem, right? The phone line comes into the house and then is split to the fax machine in the living room, and one cord goes over to the office. I had jiggled the wires going in and out of the boxes early in the phone- not working period, but not actually opened them. (And of course I’d unplugged and re-plugged all available connections.) So we opened the one in the office which looked fine, and then the one in the living room where I discovered one of 6 wires had broken and become disconnected. So Novalinh and I fixed it - I showed her how to safely use scissors to strip the insulation - she wanted to use a kitchen knife and her thumb - and we wrapped it around the little terminal and screwed it back in (using my small Phillips head screwdriver from the multi-tool I bought at REI the day I left Denver.) And the phone is working now! So hopefully we saved a few tens of thousands of kip to have someone from the phone company come out. Maybe it’s silly to be proud of such a small accomplishment, but at home I don’t know if I would have solved the problem on my own - I would have asked an electrically inclined friend to take a look at it. Here, I’m probably the HF staff with the most electrical experience of anyone (thanks science fair projects!) and was able to use logic - though it took me long enough - and basic fix-it skills to do it on my own.
I’ve been in Laos for more than a year now. My one year anniversary of life in Laos passed quietly on August 22nd, while Brent (a friend from residency) and I were in Luang Prabang. I didn’t even realize it was an anniversary until the next weekend when my Dad pointed out that I had now been here for more than a year. And now I’m getting ready to come home - the last few weeks have been a whirlwind of planning for when I am no longer teaching (making sure the residents have teaching arranged), getting things ready for the new coordinator (Emily) who will arrive while I am out of town at the end of October, updating sign outs, and planning my travels between now and December, when I come home to Denver. On Saturday I fly to Udomxai and meet up with Leila, and then we’ll go on together to Pongsali - one of the far northern Lao provinces, and one of the hardest to get to. From there, Luang Nam Tha, Muang Sing, Huay Xai, Mae Sot Thailand, and meeting up with my MN friend Ken in Chiang Mai, from whence we will return to Lao and do some ecotourism in the north, and pass through Vientiane again in mid-October on our way to Vietnam. I’m going to be quite the nomad for the next few months. I’ve also been trying to meet with all the relevant teachers, administrators, etc to discuss plans for the next 3 months, help the ID ward get started writing a fellowship curriculum (because I’m an expert on curriculum development. . . um, not.) and make sure the office will continue to function in my absence. So things in sleepy Vientiane, in the Lao PDR (Please don’t rush) have actually been pretty busy for several weeks. We’ll see if everything gets done . . . and I’ll try to blog at least once more before I go off into the wilderness.
Oh yeah, yesterday was the 10th anniversary of 9/11. I managed to almost completely avoid the coverage of the anniversary, just as I managed to pretty much avoid the 24/7 news coverage 10 years ago (I was in Budapest, Hungary studying abroad in September 2001.) I have been lucky to be in a place where I choose how, when, and how much to access US news at both times. Maybe I’m insensitive, but other than New Yorkers and people who lost loved ones or friends in the towers and planes, I’m not sure putting a lot of emotional energy into this anniversary is useful. Rather than focusing on how we were victimized 10 years ago, shouldn’t we be worried about the problems our nation and the world are facing right now? Shouldn’t we be working on economic recovery, universal health care, and thinking about the 2 wars that we started in the aftermath of 9/11/01 and what in the heck we are going to do about them? I don’t want to deny that 9/11 had a huge impact on our nation, but I would like to see us looking forward and working towards peace, reconciliation, prosperity, and human rights rather than looking back fearfully and tearfully.
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