largest hilltop village in the world

One word comes to mind when i think about this place and our trip - barriers. and signatures. Our health program workshop was an uphill battle, figuratively and literally. Starting from the numerous permits and tourist restrictions to the overwhelming level of bureauracy that we faced every day (to get out of this freagin insurgency-ridden town, i needed to walk through 5 security checks and get 4 signatures just to board the plane. Even my carry-on needed 2 stamps) to the fog that almost forced us to reroute our trip in order to catch all our connecting flights through the rough terrain (a 1 hr plane equals about a 35 hour busride), everything was a challenge. More importantly, other barriers included lack of communication, lack of coordination, high cost medicines, restrictions on supply chains, language barriers, lack of human resources, lack of education, little to no funding and political instability. Probably the biggest barrier was ignorance that perpetrates the minds of the government officials. The ministry of health of this state was a racist, blaming the ethnic minorities on pretty much all the problems of her state and beyond. "They bring over drugs, HIV and malaria and crime". During dinner at her house, she explained to us the horrors about 'bee wee' a local yeast that supposedly quickens the fermentation of bootlegged liquor here (this is a dry state) that the burmese use which causes major bleeding and ulcers all the while she is forcing fosters beer and red wine down our throats that she illegally smuggled in her government issued car. she claimed that rape was the biggest crime and that a chin (burmese ethnic minority) is usually the perpetrator. She also said that hiv/aids is a consequence of bad things a person does like sex work and druguse, but it you get HIV, at least you don't die right away and you have time to pray and repent for your sins. Whereas with Malaria, it doesn't discriminate between [good and bad] people so this is a disease that she is fully addressing in her state. Her idea of fully addressing this health problem? Passing out untreated bed nets at drug depot centers (that don't serve migrant populations), using sub-par antimalarials, and breeding drug-resistant malaria by giving chloroquine to the army as a prophylactic once a week. besides her being a big disappointment as a strategic health partner, everything else was inspiring. The health workers in our workshop were eager to learn about the health status of their people, they're equipped and ready to go out in the field to do some malaria screening and data collection. But we're still figuring out channels for drug supply distribution. The 4 of us had a ball every morning eating our dal and chapati, where the waiter, having finally figured our routine, out didn't seem to mind serving us anymore. And our also routinized lunch over at Hotel Chief was always good, where the menu read "designed for smart people". We're now in Kolkata, happy to be sitting in this airport for several hours and i'm looking over to see tom and luke trying to connect to each others' laptops, chatting away about the next program they'll design, and once in a while asking me for the umpteenth time if i don't just want to head down to maesot with them for another week of more workshops. As for me, i'm health-programmed out and all i want is to be home, taking a crap like a normal person and then taking a hot shower and extracting the multiple layers of exhaust out of my nostrils that was blown into my face every day for the past week or so in this hilltop of a city.

goggles

i just discovered the beauty of goggles. not google, but goggles. for 31 years, i assumed that goggles leaked water into the eyes and these were futile for contact lens wearers. i was wrong, and today, i was loving swimming laps in the pool, free like a dolphin.

S.A.W.

Today we visited an organization (Social Action for Women) that runs a handful of services (children's crisis center, safe house for women, hospice care for HIV+, and education ) for mostly abandoned Burmese children in the border town. we played down by the banks with the kids, who all had a serious case of scabies (need to do cost comparison to dump all existing mattresses/towels/clothes vs continue buying meds for bugs and symptoms. i say dump all the stuff and buy new, treat the kids once and for all rather than continuous symptomatic treatment. at least it would improve their daily quality of life to eliminate the scabies once and for all. how much would this cost? if anyone is interested in pitching in a $100 bucks, that will buy new mattresses for 40 kids). i'm pitching in to buy a new washing machine for the center...

also, there was a woman who is HIV+ who had a enormous tumor on her eye the size of a grapefruit. she had a dressing over it so i couldn't see it, but it was very maladorous from the dead tissue spreading throughout her face. i felt so bad. i went with my doctor friend, and while they were explaining her situation to us, you could see the pain and humiliation that she was experiencing. the tumor was described as being a big open sore, like a volcano. and because of the dead tissue, flies got in there recently and laid their eggs, which resulted in maggots crawling out of the poor woman's eye. the local clinic that serves burmese migrants could not help nor the local thai hospital.

The data (obtained from biannual household screenings) show a decrease in proportion of villagers tested positive for Malaria where interventions were implemented.

back on the T/B border

Oh soo wah my peoples? (that means how are you)...I'm back in Thailand, it's great, as usual. Am here to facilitate a couple workshops and help with some data (1. malaria control - implementing a new artesunate based combination therapy and 2. program planning/mortality/human rights data collection training). It should be interesting given the recent flurry of military aggressions against the ethnic minorities, particularly the karen, since the junta moved their capital away from Rangoon to a city farther north (and closer to karen state). I've been pretty swamped and haven't had much of a chance to write. I actually just got back from a village that I can't disclose the name of b/c the village is 'inside"... plus, Judy C was out here and we totally got to bond during our 4 hr truck ride that went from "what fun sitting back here with the wind blowin in our hair" to "what the fuck. it's raining and we have to keep each other warm with body heat." Because of all the rain, we rode a tractor into the hills as far deep as we could go thru corn fields and then walked the rest of the way. There we did some survey pretesting with the villagers and reviewed their malaria control program, in addition to teaching yoga to the entire village, after which we had a big longan fruit ceremony where they clinic staff sang their village theme song. I'm excited for this new survey b/c we'll be getting some new information - like the total goiter rate, and whether or not an area is endemic with filariasis. (that's the parasite that causes elephantitis of the balls, legs, arms. apparently, you only need to find 1 positive to consider an entire area endemic. we tested out the diagnostic tool on a couple folks here in mae sot and found 2 out of 6 were positive. scary.). I will definitely have to take a treatment course to rid my body of any filariasis worms. A little DEC+the good ole albendy. Did I mention the trauma workshop where the medics used pigs that were injected w/etomidate and then suffocated as subjects to train tracheotomies and other things that these backpact medics have to do due to landmine explosions and other jungle-related injuries? other than that, life is pretty quiet here - no dog attacks, no streets flooding. i've been eating great a ton of green papaya salad. i'll be heading back to LA soon where i'll have to continue my job search, probably go back to my old research place and kiss some butt. speaking of which, i made out witha couple boys in LA before i left. hot. omigod, i gotta continue some translation work...sawadeeKAAAA!!!

hairy pet

OMG, have you guys ever had a clogged bathtub for days b/c your property management team is really just a gang of slum landlords who fire the maintenance team leader and so you're left with the one guy (JACK, with the front tooth missing) who, when you ask to please not smoke in your studio, he throws it out in your hallway and stomps on it, and who is averse to long term solutions, therefore brings over, the bottle of super-dosy acid that, according to him, you mustn't get even one splash on your skin, b/c it would burn right through the bone? Ouch. And that is what he's poured placidly down my baththub drain while simultaneously telling me about the guy he borrowed the acid from has a hole in his thumb that you can see right through because of his ill-handling of this crazy ass shit. I'm wonderinh... a) Don't you need like a license to handle chemicals like this? and b) What would happen if I actually poured an entire bucket over someone? Would they fry away into non-existence? Anyway, two days later, my tub clogs again. And so I, rather than bitch and complain, choose to look at the bright side of things, and use it as a motivation for me to work out at school and use the locker showers instead. It's been over a week now, and considering he's the ONLY maintenance guy in charge of 35 apartment buildings, Jack's E.T.A is looking pretty dismal. Therefore, I take matters into my own hands and try the plunger (last time i tried this, all I got was black corrosive sludge surging up and not going anywhere). But, I do that mental exercise that I do right before I'm about to eat a deep fried frog and now I'm prepared to take on whatever may creep up from my drainhole. And so after plunging away, I write this email partly out of disgust, partly out of relief, but mostly to settle my queeziness. I guess writing this email is kind of like that phenomena some of you might be able to relate to - you know, when your feet smell, you want the person next to you to smell it too? I guess you really had to be there to experience what I just did, b/c it reminded me of that same extraction I had to go through in thejungles of Peru when I had the worm in my breast. You see, as I was plunging, I noticed this black blob POP UP!... and as soon as I maneuvered my plunger to get a hold of it, it would immediately SINK RIGHT BACK DOWN the drainhole, like it KNEW that I was after it! With each round of plunging, the black blob's mass emerged more and more. Well, the rest is history, and I'm about to clean up that hairy mess, but not before taking a foto of it and disseminating it to you all...

life on the T/B border

Yo my peeps! The other day at the Mae Tao Clinic here, this K---- (ethnic group from B----) dude came in b/c his penis hurt. When the doctor and my med school friend probed the patient (no pun intended) about it, they found out that he had injected coconut oil into his schlonger to enlarge it. I guess they're late adopters of the penis pump here. so, I'm finally starting to adjust to all the bugs over here, they can't seem to get enough of me and I'm slowly accepting the fact that these bugs are here to stay. Fortunately, I don't think any of them have the potential to lay larvae in my body like Amazon bugs, thank god, but I have other things to worry about - malaria, dengue, Japanese encephalitis, cockroaches the size of mice that hopefully don't fly. And mangy dogs. dogs here suck, and they like to bite people, like me. I got attacked by a dog last week, possibly rabid, so I'm on now a month-long, 5-injection course of rabies vaccine. Really, it wasn't too bad, my leg got a little gashed up, no stitches though. As for my work, I had the chance of attending a BP District Field meeting held by my org and their collaborating agencies at a location i can't disclose. Let's just say I had to dress like an ethnic K---- and live in a refugee camp near the border to attend this 4-day meeting. So there I sat, shootin' the shit with the ------------- etc. I mostly sat and listened, but got to chime in once in a while when they mentioned human rights survey, advocacy, or they needed an explanation on some public health terminology. Got to chew some betelnut with them. Was constipated for 7 days. My work has been picking up, as I'm about to start up training sessions. I'll have to travel north for a week, then south a week later. this is because we have a bajillion logistical hurdles to go through. like having to sneak medics into thailand from b----, how to rent a truck to carry to transport illegals, how to ..one of our budget line items is bribing thai officials to permit road access...we were even trying to figure out a way to carry our printers on a boat to take to our trainings...besides all that excitement, the food is just as exciting, especially since there's always an element of surprise and I get to eat so many things out of plastic bags, even my lemonade. If I'm lucky, I actually end up getting what I ordered. And that happens when I can point to what I want. Otherwise, I just accept the fact that I might be eating fishball soup, again. ok, miss you all dearly, i gotta meeting to run to, SAWADEEKAAAA!!!

ps. i really liked to wash down fried amphibians with a cold iced nescafe in a bag on a hot summer afternoon...if you look close, the mommy frog is holding on to her baby frog when they fried the crap out of the two.