Deciding I could afford a weekend break from reading redundant proposals and reports on the reproductive health of Burmese women, I considered my options for a regional escape. It was Friday before I started thinking about it, and while the large northern city of Chiang Mai with all its cultural offerings was certainly an option, it would be a pity not to contact beforehand the two or three friends of friends I had there and at this point it was a bit to late to do that. I hadn't figured out how to make phone calls and there's no guarantee of someone getting and responding to email after 4pm at the end of the week.

When I mentioned to one of the medics that I was thinking about going to Chiang Mai, he suggested I check out Sukothai. So on Saturday morning as I lay lazily in bed listening to the rain that was falling for the first time since I got to Mae Sot, I let the 8am hour of departure time to Chiang Mai pass while I further considered my options. You people with clear responsibilities may not be aware of how much time it is possible to fritter away, staring at the ceiling considering one's options. Joni Mitchell calls people like me "another crazy you get from too much choice." I take that personally as this is what has lead me to Thailand.

I took a slow coffee at the guest house restaurant with Anusha, a Sri Lankan nurse practitioner from L.A. who was here with Manny and the others to work with the backpackers. She had recently left her doctors-office job where she did prenatal visits (but no births) to work in an emergency room, as she liked that she could do her 10 shifts in the beginning of the month and then be able to work on other projects, like starting this organization GHAP – Global Health Action Project – with some other medical types with, and come to Thailand to enact it. I would have to consider this, as my work schedule last year was constantly interfering with family reunions (of the blood relations and ultimate frisbee tournament types). There must be some hospital L&D departments that could enable that sort of schedule. Of course, ER is very interesting, and ER docs are some of the few of their breed that seem to have retained their souls despite the seering effects of medical school.

Anusha got me off my butt and out the door so I wouldn't miss the last bus to Sukothai. The timing was good, there was a van filling up just as I got there so I didn't have to wait long. The schedule says they leave every hour until noon, but I think they fill up and go. I connected through Tak, the province capitol, and got another one to Sukothai which annoyingly stopped for no reason at a roadside market for an hour on the way. The road from Mae Sot to Tak is hilly and twisty, a lot like Route 9 in southern Vermont where a Bennington College student on a motorcycle is killed periodically. The morning rain had been light, which I understand is more hazardous than a heavy, cleansing rain. The layers of oil dripped on by vehicles over the dry months prior aren't washed away by drizzle, just lubricated enough to make a scary, skiddy surface, particularly unsafe for scooters. We passed no fewer than ten accidents on the hilly route to Tak. However, most looked like fender benders, none serious. Perhaps this is why it took me four hours to get to Sukothai.

Tak is due east of Mae Sot, and Sukothai is due north from there. I spent the afternoon on a rented bike cruising around the park that is the town's main attraction, riding between piles of 800 year old bricks that were sometimes still arranged in the pagodas they'd been built into in the 12th century. Sometimes they were just piles of bricks. Each of these wats (temples) was in honor of a particular monk. Some featured styles from the Mon dynasty, some the Khmer. One associates Khmer with Cambodia, if one forgets that borders are fluid and that culture creeps. I read the descriptive signs but wasn't really able to see the differences in Khmer and Mon features. One afternoon couldn't be expected to compare with the weeks of Gothic vs. Romanesque I had in college.

Lonely Planet gave me choice for Sunday of town to the north of Sukothai, each featuring either locally made pottery, hand-weaving, or more wat ruins. I opted for the weaving village since the LP wasn't that clear about whether one could see pottery wheels in action. Since I've been sitting at pottery wheels myself since I was nine years old, and as recently as last August, I would truly love to see what the locals do, but it seemed more likely I'd only be able to see in town what was locally made 500 years ago and dug up in fields.

On the bus on the way there it took me 20 minutes to sort out with the ticket collector that he owed me change from a 100b note, not a 50, which is probably why eventually I was instructed to disembark from the bus in a town that had not been my destination. And I had been under the impression that Thais were so nice. Since there are no signs in this country that I can read, it took me long enough of the afternoon to figure this out that I couldn't have been sure to be able get a bus to the town I wanted, then back to the hub town and eventually Sukothai again before night time. But I spent an afternoon seeing locally made weavings in stores in town, which I hadn't seen in Sukothai or anywhere else, and at the very least, seeing another Thai town.

I have to say, however unfortunately, that Thailand seems to have been paved over and had parking stripes painted on it. Much of what one sees from the main roads reminds me of Long Island 25A Northern Boulevard: muffler shops, car logos, billboards, flashing neon. Large-leafed banana trees punctuate the industrial wreckage, but little attention has been paid to preservation of aesthetics. One has to do a double take not to miss the lone warm, homey carved teak stilt-house surrounded by banana trees with a wood footbridge leading over the road-side ditch to the front door. You can admire it on your second glance in that direction if you don't blink, but the big plastic sign of the place that can fix your flat tires gets your first.
- posted by melle @ 7:51 AM

 
I still needed a couple more documents from Sophia before I had all the material I needed to write this paper for Dr. Cynthia. Sophia is out of the clinic a lot, at a conference teaching TBAs (traditional birth attendants) or TBA trainers, at a meeting of local aid organizations, translating someone else's lecture or something. I'd guess she's around 25 but could be older, but does have a lot of responsibility. Dan set me straight the other day, assuring me that Sophia is a fine clinician with several years' experience doing births and family planning and the whole gamut. He reckoned that if she was pushing me toward doing an exam on a laboring lady, it's because she was being lazy. I forgive her, she's a busy gal. This is probably how she avoids ever seeming stressed out.

This week she was on afternoon/evening duty and I'd forgotten to check around the clinic for her before leaving for my afternoon bike-run, which followed by a ravenous hunger for a curry & Pad Thai and sometimes an internet caf้ session, can be a five-hour span of R&R at the end of a day. This night it was about 9pm before I remembered that if I didn't hit Sophia up for the papers tonight, that it would have to wait until late in the afternoon the next day, and I was eager to get this thing written and done-with.

This paper project in the middle of my humanitarian mission was feeling like the unpleasant shocks I got my first year of college. In high school when we were assigned a specific paper topic, I would often present the teacher with an alternative one I would prefer to write on, and I was rarely denied. I applaud this liberal policy, as I think most important for the 16-year-old was to learn to write, to learn to like to write, and to like to learn. And maybe to grow up be someone who would like to write about learning to like to learn to like, er, sorry…

Anyhow, come college, I stubbornly got Cs on papers more than once, with the explanation from the professor being, "This is an A-quality paper but not on the assigned topic. For the topic assigned, it's a C." I suppose there would come a time when I would have to learn to do what other people wanted, but it wasn't easy. Even worse, I came to be skilled at knowing which teachers valued quantity over quality or substance, and put out accordingly. Dutifully doing what you're told doesn't do much for one's creativity in the macro sense, but as every job in the real world has its elements of B.S., it's good if you can learn to take pleasure in the process of executing someone else's ideas, and get your smile from putting a personal touch on it.

What I would like to be doing is becoming a fixture in the RH (reproductive health) department so that the medics get use to me and trust me, getting to recognize their shortcomings and trying to make up ways to improve their systems. I have several ideas on the burners on slow cook. However, between my own projects, the paper for Dr. Cynthia, languishing efforts to learn three languages, and the bike-run escapes and email sessions that make up a majority of my social life here, I've had to set limits on how much I expect myself to do at once. So I’ve put the clinic projects on hold until the paper was done. At moments of low motivation I feel like I’ve only got a C-quality paper in me and I’ll get thrown out before I get to do the fun stuff.

Nine o'clock this particular night, I got on my bike again to go back to the clinic to find Sophia. The road is lit through town so as I passed No.4 guest house where I first stayed when I got here, I saw the dog angle toward me and pick up its pace as I approached. It was too late to dig my whistle out of my pocket, but just as I swerved and picked up my foot to kick the snarling dog away, a guardian angle motorbike sped up between us and shooed the beast away. The scooter guy seemed to hang behind me just a bit longer than I expected and really made sure the nasty thing was back lurking in its shadow before scooting on ahead. I gave him a grateful smile and a Kaphunka to thank him. He seemed happy to oblige.

Past where town ends, the road is unlit and under construction, and the Thais' idea of a safety cone is a striped broomstick stuck in a paint can full of cement, so the ride at night is a little scary. But there was a cool, crisp smell coming off of the fields to the sides, and frog noises, and it smelled like all the summers I have ever spent outside of the city. Those dream places so distant in time and space were here, now.

The clinic, busy as the marketplace in the daytime, is like a garden at night. This is a desert climate where it is hot and dry, 90oF in the day, and drops down to long-sleeve temperatures with a crisp humid edge at night. Often I go to bed in a t-shirt and wake up in the middle of the night having to put on another layer. It was strange to see the dust all settled, smell night air and not people. I could feel my eyes, nostrils and ears dilate to take in the changed stimuli.

I wonder if I shouldn't change the names of medics I mention here. I don't want anyone to get in any trouble.

So, sitting in the sitting area at the entrance to the RH-IPD (in-patient dept.) was the medic, er… Poe, whom I've spent the most time hanging out with. She was crocheting and chatting with a fellow, so I Ha-la-gae'd them all around and sat down to admired her half-made blanket with a pattern that looked like stacked fruit baskets. I asked who it was for, and she said, For you, if you like. I seriously worry that she will spend a month making a beautiful blanket that her sister in the refugee camp could desperately use, but give it to me. For me to give her my bicycle when I leave would be a sorry exchange.

Poe doesn't smile much, or at all. It's kind of like a vocabulary word she just never learned and manages fine without, and you wouldn't notice unless you were looking for it. I saw a kind of smile in some of the pictures she showed me a few weeks ago in her room, but she looked guilty doing it.

On this evening, she had not much to smile about, except perhaps her own contrivances. She told me she had something important to ask me about. She had just learned that an older woman from her village had just died from complications from an abortion some weeks earlier. "She was really old," she told me, "42 years old. Some people ridiculed her for being pregnant when she was so old, so she had an abortion." I hope her actual motivations had more to do with the fact that she already had seven children, as Poe told me.

Abortion is illegal in both Burma and Thailand, so tragically this is not an uncommon occurrence. Deaths from abortion are an inevitable upshot of virtually no access to family planning or safe, hygienic abortion. When will lawmakers learn that women will seek to end unwanted pregnancies even when it means risking their lives to do it? In all cases, a woman will choose family planning over abortion, if she has that option.

Even in the States when abortion was illegal, women knew that if they could partially induce an abortion or just cause some bleeding, there were hospitals where the job could be safely completed. This is what happened at the State hospital in Brooklyn, this is what happens at the clinic. What this means, however, is that a woman will present to the clinic with a cervix lacerated with a q-tip, a uterus perforated with a crochet hook. She may already have an infection, be septic or hemorrhaging, and may still die. The lucky ones can cause just enough bleeding to convince a medic that the spontaneous abortion is well on its way, and be taken care of without consequences.

Like all the medics, Poe is Karen, a hill tribe minority population from the large Shan state on the central east region of Burma, just over the river from Mae Sot, Tak, Thailand where the clinic is. The KNU, Karen National Union, is the military branch of the rebel groups fighting off the SPDC, the official military government of Burma. In the area the KNU controls (as I have been picking up in bits in pieces), there's dire poverty and no infrastructure, which is why so many Burmese come to Thailand to work in factories, as domestic help and in restaurants and guest houses. On my bike rides out of town I have come to realize, seeing all the faces painted white-yellow, that a good number of the residents of Mae Sot are from Burma. Stupidly, after a month of frequenting a certain nameless restaurant we call "Marble Table-top", it occurred to me that the shy gal who serves me the most delicious spicy mango salad with peanuts in the world wasn't responding to my Thai Kaphunka, and has declined to take my dinner order since I've learned to make it complicated in Thai, because she is Burmese. Just like the staff of my guest house, just like the gal who gave me the most painful, unrelaxing "Thai massage” last week. The work in Mae Sot, Thailand, is done by the Burmese because they can't make a living farming rice in Burma, despite having been one of the top rice exporting countries in the 1950s, because now the military buys at a pittance all rice above what feeds the family, leaving only that amount of the very poorest quality rice, and loose change that barely covers vegetables to go on top.

Dire poverty and no infrastructure means no healthcare, which means no family planning. Poe told me she wants to bring family planning supplies over the river to the women of her village. She thinks a bag full of Depo injections would be best, since each one lasts three months, but isn't sure how much they cost in Thailand. We calculated that they're about US$3 each in Burma, but she wasn't sure even of that. A pack of pills for a month you can get over-the-counter in Thai pharmacies for about $0.62. Perhaps I should be sending packs of pills back to my impoverished friends in the States who pay up to US$30 for a month's supply, plus doctor visit costs. Travesty.

I suggested to Poe that she talk to the Backpackers before they go back to Burma at the end of this month. They might have some suggestions for getting medical supplies across the border without army interference and possibly dire consequences for herself. Poe shuddered and gave me a side-long glance and said, "Backpackers are KNU." I was confused, because I had thought SPDC was the enemy of the people and that the KNU were the defenders of the Karen.

Later I would bring this up with Olga, both Poe's determined inspiration, and what the deal was with the KNU. Olga assured me that the KNU is a military like any military, with military mentality, run by a bunch of old men abusing what little power they had. She told me an anecdote of a couple, a consenting man and woman, who sneaked off together to go mess around in the bushes. They were caught and given a standard KNU punishment of 100 punches each, real, punishing punches, she said, and made a fist and a face for emphasis. Olga had it in for them this night as the KNU has recently put out propaganda denigrating the attributes of vasectomy, the inaccurate gist of which is easily guessed. However, she was also gleeful because she had just finished compiling the glowing family planning statistics of the clinic (which showed a continuing trend of a dropping ratio of abortions to family planning visits, and births to family planning visits), and that just hours earlier a representative from the Burmese-English Border-region health info publication had taken down her stats. Moreover, a male family planning medic had agreed to write an article for the monthly, extolling the value of vasectomy.

I hadn't realized the Backpackers were involved with the KNU, but apparently they travel with their backpacks loaded with medical supplies to the under-served areas, under KNU protection. While what they carry is meant for civilian populations, if they are caught by the SPDC they are punished for supplying the KNU. Although I haven't been told this, I wonder how much of the supplies are actually used for the KNU. I suppose it doesn't matter, as people need treatment whether they're injured with farming equipment, landmines or guns.

Manny, the filmmaker from LA who was here the first two weeks I was here, told me about filming visiting doctors giving a landmine workshop for the Backpackers. I got a bee in my bonnet last summer, wanting to learn about how to detect and diffuse landmines, but the closest I've gotten has been The English Patient which I saw in the theater when it first came out. This landmine workshop was about amputation. Manny told me that in addition to hundreds of backpacks that were donated to the Backpacker Health Worker Training program by NorthFace, Leatherman had also donated a number of their folding multipurpose tools. They were using the saw feature on Leathermans to do amputations.

If Poe didn't want to be involved with KNU, I urged her at least to talk to Olga for ideas, but especially to talk to Dr. Cynthia, who not only might be able to outfit her with supplies but also might have some safety suggestions. But Poe was determined to do reconnaissance on going back to the village by herself and then maybe bringing others in on it. Then it was I giving her sidelong glances, urging her to be careful, and strongly recommending she at least let others in on her plans.

As the conversation wrapped down, out of my backpack I pulled a few individually-wrapped morsels of special dark from Maison du Chocolat that my mother had given me before I left NY. I offered them to Poe and the fellow who was now dozing in the chair on her far side. They taught me to say, "Would you like chocolate,” in Burmese and Karen. This is one phrase that no phrase book I've ever picked up has ever offered. They're full of ways to ask, "May I have…", "Can I please…", "How can I…", but they never give you a way to offer anything to anyone else. For a foreigner in strange land who is so constantly dependent on other people, it is immensely gratifying and rewarding to parties on both end to be able to offer something, in the local language.

Eventually I actually did find Sophie. It was late and near the end of their shift so I "Ba jai lay chocolate?"'ed her, which she graciously accepted it. We looked at the documents on the computer that I was missing, but they seemed to be duplicates of reports I already had with just a few dates and figures changed, so we decided I didn't need more copies after all unless Dr. Cynthia had other versions.

Poe and I agreed to spend more time talking about this the following week when she was on the daytime shift and we could perhaps meet in the afternoon. As I left there was a fellow sitting under a tree on the clinic courtyard perimeter, strumming a guitar. People were sitting on benches chatting. It felt like a college campus.

Sitting against a wall by my bike were three female medics I recognized, squeezed in next to each other as if it were 10 degrees out. Two of them were from the RH out-patient department, and the third was Cheri, the medic who doesn't like me. I amused them with a Ha-la-gae and a nod, and blew them away with Ba-jai-lae chocolate?, handing out my last three morsels. I biked home, wondering how I could fit that phrase into my Midwifery in Seventeen Languges phrasebook.

I just want everyone to know that I went through two packs of gum in the past 2 hours while writing this update. Grapefruit flavor, and now Muscat, which looks on the package but tastes little like green grapes.
- posted by melle @ 3:55 AM

 
After a day at the clinic figuring out that I would have to rewrite the prenatal chart forms, Dan told me that a few people were getting together for dinner, then watching a film about Burma or something that evening. This would be a welcome alternative to my planned afternoon ride and run.

Manny, a photographer from L.A. who had been here as part of the backpacker training workshop – have I told you guys about the backpackers? is anyone reading this blog? remember anything about the backpacker medics? Manny had told me about S.P. Kitchen, supposedly the nicest restaurant in town. It had a nice Italian menu since Elizabetta, an Italian doctor who has worked at the clinic full-time for several years now, had taught them how to make a real lasagna, ravioli, Bolognese sauce. Manny said he keeps planning to teach them how to make Mexican, as their menu lists:

Mexican

taco B40

But he hadn't gotten around to doing it on his two-week long annual visits yet.

I thought about this and considered what I could offer: a New York style Pad Thai or Tom Yum? I could perhaps offer Uzbeki carrot salad if I could find dry coriander, or Turkish cucumber salad if I could find fresh dill, or Mom's famous stuffed eggplant (Mom, you need to give this one a name – East Eggplant?) if I could find couscous).

I hadn't been to S.P. yet since I've been pretty thrilled with the Pad Thai and Tom Yums in town and hadn't yet been craving lasagna. The restaurant is away from the two parallel main streets of town, north a ways up on the Asia Highway which I cross when I escape town on a bike, but not on my route so I never thought about stopping in. I got to the restaurant at 6:30, on time like a well-trained New Yorker since the movie was to start at 7:30, but I was alone in the place until nearly 7pm when people started to trickle in.

Chris, an HIV specialist from Virginia with a motorcycle whom I'd met several times already, arrived first and sat down at another table in the empty restaurant. I could hear Dan and Jane parking outside so I waited for them to come in and ask Hey what are you guys doing spread out around the room?

Jane came in looking all pink and asking if the dog from hell next door had attacked us too. Being 13 weeks pregnant with her belly starting to poke out under her shirt a tad, I wonder what other hazards she has to worry about in this place where salad and non-bottled water are recommended to be avoided.

S.P. Kitchen seems to be the clubhouse for Westerners, as there were no Thais to be seen, and the lot of us who were dining there that night took up four big tables. Kurt and his wife, a couple in their 40s who are well-known around town for their two-person bike, were dining with a bunch of other 40-something I'd never seen before. There was a group from the Karen Women's Coalition that included a woman who sounds Welsh, who ubiquitously has a fat, little Burmese-looking baby strapped on in a pack. We were joined by Yvonne, a 40-something Ozzie gal who, with her female companion and Chris, kept slipping outside to smoke. I was happy to get to talk to Anna, the project director for Doctors of the World, the organization that had put me in contact with the clinic. I am still hoping to link myself with them officially so I can put them on my c.v. when I get home, and maybe be able to tax-deduct my expenses for this venture. Anna is about 24 weeks pregnant so will probably disappear from the clinic before I do.

Dan was contemplating the curry he recommended highly, but I like to order things I can't make at home and there's plenty of curry in the kitchens near home. They were out of the fungi lasagna so I had the spinach ravioli in a butter-sage sauce, and it was delicious and definitely the most filling meal I've had since I got to Thailand. I also had a green salad and felt just fine the next day. Dan had the cannelloni and we all partook of the plates of delicious bruschetta that Jane said she had absolutely no choice but to order.

Long around 8:15 some of us started to wonder about the 7:30 movie. Others were ordering desert. Someone phoned someone else to go to the movie theater and stall them so they'd still let us watch it. Have I told you I'm the only person over 5 without a cell phone in Thailand? This was a bit of a bugger on the otherwise tranquil ferry ride to Ko Samet on my first weekend in country, but I've gotten over my Marco Polo fantasies.

The movie theater is a room with 18 seats in an extension off of someone's house, where there is also a lounge with a karaoke set-up. Unlikely I would find a crowd here as much fun as Nif and Nick to do Summer Lovin' with, especially since everyone is pregnant or has a baby, but maybe I'd eventually meet some of these conspiracy theorists to have a party with, though such people tend to express themselves in low tones and not into microphones. No remote hope of rising to the levels of the Karaoke Grammys I saw in Williamsburg last fall, but some Beetles or Elvis would do.

Speaking of Williamsburg, and how I have friends there I'd like to hang out with more often but it's just so bleeding difficult to get to from Park Slope, it would be so grand to find a way whereby I didn't have to take a 45-minute F-train subway through Manhattan to get from one part of Brooklyn to another, or wait interminably for the terminally slow G. Scooter culture in Thailand would seem to offer one option except for the difference in climate between here and home. When we don't have snow and black ice, we have downpours and greasy streets, and you can't bring a scooter on the subway as you can with a bike. Bike is my transportation of choice in New York as for trips almost anywhere in Brooklyn and south of 4th St. in Manhattan it is as fast as and often faster than the subway. And most glorious way to go when a trip included crossing the bridges. Avoiding the aggravation of the subway is worth the extra five minutes to me to cool off at my destination.

Still, that trip to Williamsburg is a drag and I always get lost on my bike. I've been seeing more and more Vespas in the city, even the police, which is giving me some hope that there may be a shift away from SUV culture at least in New York where it is ridiculous to have one. I'd be tempted to get one myself except that I'm afraid I wouldn't get any exercise on busy weeks. I think on a motor-controlled machine you're probably not as zen-in-tune with the thing as on a bicycle, which is entirely directed by you and the bumps in the road. I know just one person who's had a serious car-on-motorcycle accident, and a disproportionate number of untimely deaths amongst friends in car-on-bike accidents. I don't know what the answer is besides getting more cars off the road and maybe putting more of those other people I don't know on motorbikes, definitely as many as possible on bicycles with helmets and opening up more bike lanes. But it still doesn't help me get to Williamsburg not sweaty and exhausted, and not late and aggravated from getting lost.

Back from Williamsburg and karaoke and into the movie theater in Mae Sot, the video we watched was taped from the t.v. in England, about how NGOs are ruining the world. They showed footage from famines in Africa including Ethiopia in the 80's, scenes from the genocide in Rwanda in the 90's, the mess in Somalia. They asserted that much of the food and monetary aid from the relief organizations was funneled through corrupt governments and often used to bolster military supplies. Such aid they said often did not relieve humanitarian crises, but instead prolonged them as they were often created in the first place by governments to control minority groups or dissident populations, e.g. by dropping bombs on or near villages on market day.

An example they gave was that after the Hutus has slaughtered tens or hundreds of thousands of Tutsis in Rwanda, they were defeated and forced to flee to a neighboring country (Uganda?). Dozens of NGOs like MSF flocked to the Hutu refugee camps to provide aid, show their organizational flags on television and bring attention to the humanitarian crisis unfolding in the camps. Meanwhile amongst the refugees at the camps were murderers who had perpetuated the genocide in Rwanda, and in fact were shown in the film conducting military training at the camps.

The critics of the NGOs shown in the documentary said it became something of a joke amongst themselves to see the NGO logos flying on flags at the camps, on vehicles, on t-shirts worn by relief workers. It seemed a very cynical criticism, suggesting that the purpose of the NGOs was fame and fortune through publicity and manipulating the media. A writer for The New Yorker charged that none of the relief workers, and he stressed not one, had been given any education regarding the political situation and its history by their organizations.

In 2001 when I was preparing for a mission with MSF to Sri Lanka, which was eventually aborted, I was told a lot about the situation with the Tamil Tigers and given reading material. The MSF rep explained to me that the reason MSF split off from the Red Cross was so that they could give temoinage, bear witness, to the crimes of governments that were causing famines and crises amongst population in the first place. While Red Cross serves a purpose by remaining neutral and uncritical and addressing only humanitarian issues, MSF will speak out against a ruling faction that is interfering with food distribution and sanitation, the route source of a crisis.

It seemed like the critics didn't understand how NGOs operate to accuse them of manipulating the media, kind of like criticizing a restaurant of serving food at mealtimes when people are hungry. MSF told me that one of their tactics was to attract media attention to a situation, so that the public would be informed of a situation and call for their governments to do something to rectify the situation.

In a case like the Hutu refugees who were being attended to by a dozen or more relief organizations after their retreat from slaughtering Tutsis, the situation is complicated and some of the criticism of how the NGOs handled the situation is justified. Oxfam was wrong – a million people did not die. Several thousand did die from cholera, but it wasn't millions and there was more than enough food aid given. This was surely due to the presence of the NGOs. The matter of how many Hutus, what percent of those receiving aid, were guilty of the genocide, is another matter.

The film was over by 10:30 and several of us had fallen into an S.P. Kitchen carbohydrate coma at some point in the last two hours, so there were some bleary eyes and not much discussion of the film. Anna at least is part of an NGO, but I'm not sure what the affiliation is of the others present. I heard some mumbling criticism of MSF, and I piped up with some of the above mentioned defense of their tactics, and got a "Yeah, well," as an answer. But it was late and we all had bumpy rides on bikes and scooters to get us home to bed. Not much point, it seemed, in suggesting karaoke.
- posted by melle @ 8:23 AM

 
More skirmishes have ensued on the home front. It seems these ants have the same taste in food I have. They haven't touched the Froot Loops or Tang that I bought in a fit of unexplainable nostalgia, since at home I favor cheese and Emergen-C. They have been caught in my seaweed snacks, pistachios, and B160 box of granola which for this cost of living is like rats getting into your truffles at home.

It doesn't help that I have no shelving so my cupboard is on the floor in a corner of my room. But if I spread the food out instead of keeping it in a plastic bag then not only do I not forget what I have, I can also tell which item is being invaded when I see a new trail of ants coming down from the ceiling. They apparently don't care for raisins, salted dried mangos or plums, gross fake Ritz crackers, or whatever is in the black plastic ant traps.
- posted by melle @ 6:20 AM

 
The bike I've been borrowing from a friend of Dan and Jane's has been repossessed, so I've had to see about getting a replacement. It's just as well as in the past two weeks I've had to use string to tie up the fender so it doesn't rub on the rear wheel, I used a rock to bang a bolt back in place when the crank shaft fell out, the nice motorbike guy next to my guest house gave me a couple of nuts & bolts to put the seat back on when it came loose in two out of three places. Best of all, the brakes have a 15-20 foot stopping distance at moderate speeds. On more than one occasion I've had to pull a Six Million-Dollar Man, using my right heal against the pavement. Most of the time I apply the brakes for a few seconds then just jump off and run the speed down, which I'm sure is really great for the health of my ACLs.

But the bell on the bike was nice and loud, the upright handlebars gave my back and neck a break, I haven't had a basket on my bike in maybe 25 years and have found it is super convenient for everything. Plus, being the classic heavy upright black bike with fenders, and looking like an old piece of junk, it was just my style. Junk or not, I've had to give it back and find another one.

On my first trip down to the Burma border when I was trying to find the clinic, I passed a shop selling bikes that quoted me 600 baht ($15) for a bike. I guess I should have grabbed one then because when I went back they asked for B1000. It seems to be convention to display the bikes without the pedals, so you can't try them out. These bikes had bent fenders rubbing against flat, cracked tires, either no basket or no seat – just not confidence-inspiring. Dan said he and Jane had paid B600 so I didn't really like it that they were now asking me B1000. Plus these bikes would surely need maintenance, and it was about a half-hour walk from my house to here, so I went back to town to look.

There are so many new motorbikes in Thailand that I'm sure there are used bikes in good condition in every basement and backyard. I went back to my guest house to find Saw, the knowledgeable 20-year old Burmese guy to see if he knew of anyone with a bike they might like to sell, but he was out. None of the bike shops in town had used bikes, but I saw a bunch of new ones that looked too small for me for B1300. A new upright bike like the one I had been borrowing goes for B2400, $60. That's the price I've paid for used bikes in Brooklyn, and less than the cost of replacing a stolen rear wheel. But after an initial quote of B600, argh.

Melinda is right. The truth is, "I lived in Thailand for less than $5/day, oh except for the bicycle I bought, daily internet use, newspapers, sarongs, bus rides, banana shakes and ant traps. But I definitely spent less than $5/day on food."

The bike rental place had bikes in the same crappy condition as the place halfway to the border. They were going for B1000 also, but the guy said he would buy it back from me for B500 in June. That was a pretty good offer, except that I know that when I leave here I'll give it away to someone at the clinic with my helmet, mosquito net, etc.

But by this time I was starting to get interested in an offer of a new bike that included bell, basket and lock for B1350. It was one speed, no gears, like the uprights, also had a low center bar good for gals with skirts, but had mountain bike tires. The roads here are in fair condition but there are lots of rocks and sewer grates and I always felt like I was going to get a flat on the other bike.

I made one last trip back to No.4 Guest House where I'd rented a bike the first weekend I was here. It was about 1pm, the guy was napping in the living room and as usual was not pleased at having to deal with the public.

"All broken," he explained.
"May I look?" I asked.
"All broken!" he clarified.
The cases didn't look fatal. "How much to buy?"
"Not for sale!" he would have me understand, further illustrating by turning back over on the mat and burying his face in his armpit.

So I got the new bike with the crucial accessories for 250% what I was expecting to pay, but it had all its parts. Maintenance was promised which was a good thing as the chain fell off the first four times I tried to ride it home, but they fixed that and I haven't had a problem since.
- posted by melle @ 8:18 AM

 
Wow! a big fat thanks to Eric for sending me a big box from San Francisco! It took 9 days to get here, and the fish crackers from one bag had exploded, so I could definitely use some reinforcements of another bag or six. He included the February Cosmopolitan so now I know ALL about LOVE and that ruffles are (back?) in. Happy I'm in Thailand. The flashlights and thermometers will surely be useful at the clinic or used by the backpacker medics who brave crossing the dangerous border to go back to Burma to provide sometimes the only medical care for miles around to the Hill Tribes. Thanks Eric, you're a star.
- posted by melle @ 7:21 AM

 
I noticed this morning that in the bathroom that usually has the most mosquitoes, there weren't any. I hesitated in the doorway for about three seconds as I registered this, then looked around to see if they were having a convention up near the ceiling or something. Instead I saw sitting at the edge of the large gash in the screen – a big, fat gecko. This gecko clearly knows where to go for the prize money.

So far I've only had about as much trouble with the mozzies as I do in summers in Pennsylvania, which isn't too much. I think it's all the chilies and garlic I eat. My sister and I used to think Slim Jims were good mosquito repellent, and on occasions, like car trips, it's still a good excuse for one.

Of course the difference between the Pennsylvania and Mae Sot mozzies is malaria. I'm running out of Skin So Soft, which became all the rage in the late 80's amongst hikers when it was discovered that even without the citronella they add these days, that it was an effective bug repellent. And I've wasted half a bottle of unscented OFF trying to steer the ants away from my bed. I have seen just one tiny little gecko in my room up by the ceiling, but there's not much of a meal for one here unless they like ants, as I've only had that one tenacious mozzie and it's been gone a few days now.

My biggest concern is in the shower, being all exposed with no possibility of keeping the bug spray on. I've forgotten about burning mosquito coils until just now. Maybe my five-minute shower will turn into a fifteen-minute ritual with mosquito incense and prayers not to get bitten in any sensitive areas.

- posted by melle @ 6:12 AM

 
Funny, the ways the brain adapts in a new setting – the sights, sounds, tastes. There's the obvious language barrier, but I am thrilled when I'm sitting in the clinic and overhear the medics saying something that definitely sounds like some portion of "Calay lo bi laaaaah," and I can guess that someone's baby is either moving or not. Other times I'm sure they've said The hat is blue, or something about angels in Spanish.

The visual aspect of adapting to look at an ethnic group that is new to me has surprised me. At first when I was new to the clinic, after having just seen a patient with one of the medics and something more occurred to me about the patient that I wanted to tell the medic, I more than once looked around the table at four or more young women with long, brown hair pulled back, and aggravatingly couldn't figure out which one I'd just spent ten minutes talking to.

Perhaps living in New York has not been good training for these kind of mental gymnastics, as one might expect. At home, it is more common to encounter a group in which there are obvious racial or regional differences between individuals. Over the weeks, without any special effort except that aesthetics interest me, I now tell individuals apart easily and it shocks me that it ever was otherwise. It has come with time spent with each of them and getting a sense of them as personalities.

I'm a fan of Sophia in particularly, who is something of a lead medic in the RH IPD (L&D). She is Dan's main translator when he teaches. Her very good English gives her opportunities for roles with responsibilities, but it's not just that. She reminds me of Zazzie and Tattie, two sisters I went to high school with who were something of idols to me. These two had such calm, quiet, egoless confidence it wasn't possible not to like them. There were on sabbatical in France with their teacher parents my first year at The Putney School and we heard plenty about them, and the fact that they were so great made them thoroughly unlikable in reputation. When they came back, there wasn't a question of them having to win anyone over, because their good characters were like math, just a fact.

Sophia has a bit of this Buddha-like serenity and substance without ego. She's a senior medic in Dan's new system to divide up the L&D responsibilities to be sure the women in labor are properly attended to. Before all that one time I pointed out someone on the board and asked her, What's up with this gal? She said, I don't know let's go check, and we brought her into the exam room. Then we both stood there and waited for the other to do the exam. Not wanting to take over, because what's the point if I do the work for them so that they actually do less if I'm around, I said, No go ahead, it's ok you do the exam. But she said, No I don't do the exams. I puzzled, Do you do births? She doesn't.

Pity that she's in this department and doesn't do much of the medical work herself, because you're a much better director when you are familiar with the work your charges do. I can still see that Sophia is a good person to have in charge as from what I can see, she is always comfortable, kind, has a good rapport with the other medics, and enjoys what she does including the responsibilities, without abusing the privilege that comes with the prestige. Her perpetual smile comes from glee, not from trying to please.

The diversity in facial features are still fascinating to me as I come to recognize them. Sophia and her quiet, more reserved sister in the antepartum department, look part Incan, with their broad, flat foreheads in line with their noses in profile. The medic who won't acknowledge me looks more India-Indian features, with her almond eyes and pouty mouth. Epo looks like her origins in China more than any of the others. I wish I could tell if it's education, an individual characteristic, or my own familiarity with them that the medics seem to have more sparkle in their eyes than in those of the patients they treat.
- posted by melle @ 6:10 AM

 
There are plenty of friendly Western middle-aged couples wandering around Mae Sot. Like Ellie and Myron they are very friendly, always return eye contact and a smile, and often approach me on the street or in a restaurant to ask me questions. The 20-somethings are a different matter. They will avery their eyes if they accidentally catch mine, and rarely return my hello as I walk right by them on the sidewalk. It's as if I'm spoiling their 12th century Marco Polo fantasy.
- posted by melle @ 7:51 AM

 
A few days earlier I'd gone to the same restaurant for dinner. I glanced over the room, smiled at a middle-aged Western couple who smiled back, and sat down with my newspaper to read about the heroic dissembling of ruling politicians on this continent and others. Seems everyone thinks the Thai and Vietnamese governments have both lost a lot of credibility over the Bird Flu Virus that has killed five people in this country and 14 in Vietnam. Just like SARS in China, both countries were slow to acknowledge or take steps to contain the virus. I could feel proud that my country doesn't generally deny the existence of things that are actually there.

The chicken is a lot tastier here than the flavorless rubber that comes in soups in the States, but on this occasion for, like, the second time since I've been here and the first time outside Bangkok when I decided to order the Tom Kha Gai, spicy coconut chicken soup, they offered me pork or shrimp instead. According to all reports, chicken is safe to eat if it's well-cooked. But if people aren't ordering it much, if a restaurant has it all I reckon it may have sat around unordered for a few days already, and have for the time being officially nixed it from my diet. I'm not big on pork; egg is unavoidable; tofu, rice and peanuts are ubiquitous, so egg, tofu, rice and peanuts it is, at least for a while.

Toward the end of the meal the white-haired Western couple came over to my table and the lady asked, "Did we happen to see you today over at the Mae Tao Clinic?"
I replied, "Depends, are you Thai Immigration Authorities?"
She chuckled, "Not likely, but, you were there, orange shirt, black pants?" I looked down at the orange shirt and black pants I was wearing, and had to fess up.

Ellie and Myron are a couple from Alberta, Canada. Myron is a surgeon, here to take part in the "mine workshop". They are teaching the backpackers how to do amputations. They gave me a few minutes of history lesson as they told me the clinic had been set up for all sorts of Burmese refugees, not just fleeing students and political dissidents. I guess it makes sense that along with people of any profile would come others with different descriptions. Since the Burmese now crack down on whole minority ethnic groups, confiscate their land, empty their villages, imprison their tribal leaders, the clinic gets refugees of all stripes and inclinations. The official legend as I've heard and read it is that the original patient population was Dr. Cynthia's group of fellow student protesters. Myron and Ellie have been coming here for 13 years, a year longer than Inge the German midwife.

Myron has a poor assessment of the level of medical knowledge of the clinic medics. When you compare them to North Americans who have had four years of medical school, four years of clinical residency and three years of a surgery fellowship, how can you really compare medics who get a tidbit here and morsel there from Western doctors who blow in for a week or two on their way to an island? If I get malaria or fall of my bike, I’d take the Bangkok hospital over this lovely local clinic where the medics have seat-of-their-pants training.

Most of the foreign aid NGOs I contacted last fall, who didn't know what they would do with a volunteer midwife, said they would require a minimum of six to 24 months from medical volunteers, that is if they had placements at all for them. I've been at the clinic for about three weeks now and I think I had the system down after the first week. The trick I suppose is being able to change the system where it may be in a rut and needs an effort to be changed. I changed the Board, as I mentioned, about two weeks ago. I didn't go to the L&D ward much last week, and by Friday the notations were all scattered about in no order. Some of the parameters I'd added were still there, but in no particular column. I will have to be more diligent about keeping this organized.

Inge was lamenting to me that in past years she'd made great headway in the antenatal clinic promoting the IUD. It's a great option for women who can't come to the clinic for Depo injections every three months, can't be bothered or remember to take birth control pills everyday, or have trouble getting their husbands to put on a condom. If she isn't at risk of getting an STI (sexually transmitted infection), it's a great method because of its low maintenance needs. Inge said they were putting in several a month, the medics were getting more comfortable with it and promoting their use amongst clinic patients. She brought over a good number of them from Germany on one of her annual visits.

Then a doctor from MSF came and gave a talk to the medics, and snubbed her nose at the IUD. Apparently the French aren't big on them. In the States too there had been a problem with them and they were taken off the market about fifteen years ago. However the new ones are far safer and more effective than the ones a number of my friends were conceived around. They're still not big sellers in NY, where the women haven't gotten over the IUD's unjustified bad reputation. But it's not a tragedy in a place where there are so many choices for family planning, and women have the education level to be able to take advantage of them all. It is a loss to the community of Burmese migrants who aren't encouraged to use this low-maintenance, long term family spacing method. How many have sterilization procedures they're not 100% committed to, or forget to take daily pills and get pregnant and undergo dangerous illegal abortions in the jungle?

I wonder whether the education and sophistication level of the medics is high enough for them to recognize that so much medicine in actual practice is almost an art, about judgment and experience, and not necessarily exact science. Like when I tell them, they have to feel the bellies of 30 pregnant women in before they give birth and then to compare what they feel to the actual weight of the newborn after birth, to learn to estimate the fetal weight with their hands. When I am doing this regularly I can usually guess within 1-300 grams, with a better margin of error than ultrasound machines that can only measure the size of fetal bones. Same as when you do a bimanual exam to size a uterus early in pregnancy to estimate the gestation. Brains are better than machines in some cases.

Inge gave the medics a seminar on a new device called Implanon. I had not heard of this back in the States. It is a replacement for the Norplant that was taken off the market in the States a few years ago. Norplant was six matchstick-size hormone pellets that were inserted in a fan-like pattern in the tender, inner aspect of a woman's non-dominant arm below the bicep, and released hormones for six years. There was some difficulty in their removal and some resulting nerve damage. Implanon is a single stick, and lasts for three years.

Like Depo, it is progesterone only, and so is acceptable for women with high blood-pressure. Depo-provera is a shot in the bum of progesterone that slowly releases into the blood over three months as the muscles, like all the cells in the body, regenerate and turn over.

I understood that Inge was teaching them that Depo and Implanon are not good methods for teenagers or nulliparas, women who have not had any children. The medic I queried about this said her reasoning was that it had to do with that progesterone use over six months can mess with the menstrual cycle and sometimes stop it altogether, as well as causing a delay or return of fertility for up to a year. These things are true, but I would question whether these are reasons to deny its prescription to anyone. The levels of hormones in today's birth control methods are so low, especially in the time-release methods, most studies show they are safe for almost anyone. Even absolute contraindications are relative. For example, it is not safe for a woman with diabetes to use the combined estrogen-progesterone pill. But, it is even less safe for her to become pregnant. Along the same lines, yes, it is preferable for a 16-year-old to use condoms so she doesn't get pregnant or get an STI from her 20-year-old semi-faithful boyfriend. But if they only use condoms most of the time, better that she still not get pregnant. Besides the social issues of being a teenage mother, her own body is still developing and needs the nutrients she eats, so she and her fetus are at great risk. My judgment says better to have the low-dose hormones. Same with when she is finally ready to conceive at 21, what's the big deal if it doesn't happen until 22?

Inge and I are both pro-IUD. The MSF doc wasn't and with a single statement caused the IUD use rate to plummet. Loose lips sink ships, says Inge. Inge doesn't like the idea of long-term hormones for teenagers and the like, but I think the relative risk is small and would encourage these methods for their convenience and reliability. It's all about judgment. I wonder if the medics have figured this out.
- posted by melle @ 6:50 AM

 
On reflection perhaps it would have been a wiser choice to have chosen to pass my reclusive day at home on February 14 rather than Friday the 13th, since 13 has never particularly given me any trouble even on a Friday, unlike a number of 14s in Februaries past. Nonetheless, I had a nice surprise over lunch.

There's a nice-looking restaurant on the southern main street of Mae Sot, which has a Swiss-looking wooden façade, high ceilings, ads on the walls for an expensive guest house room and Thai medical massage (emphasis theirs), and a long menu in English. They usually remember to put in the tofu in the vegetarian dishes called, like, "Fried rice with tofu and cashews," and I've never been surprised with any uninvited shrimp. It usually takes them three or four tries with deliveries of soy sauce and water to get that I'm asking for chilies, and this has happened several times now. Yet the food is pretty good, it's easy to order, and I get the feeling this is where the gem traders go for long lunch breaks. I've been too chicken to go into the crowded shops with glass display cases, I guess because they are SO crowded that people spill onto the streets, and I hate crowds most of the time. They're across the street and down a little ways from this restaurant that I go to all the time, so eventually I'll check them out.

Clinic ended early on Saturday so I went back to town, got a newspaper and went to lunch. Over my fried rice with tofu and red curry, I was shocked, shocked! to read about President Bush's defection from the National Guard during the Vietnam war. So dismayed by this "war president" that I probably won't vote for him in the fall. In fact, I probably won't ever again speak to anyone who does, except my Nana for whom we make all sorts of exceptions.

I bet I had a pretty sour look on my face, but when I looked up to see who was setting off my who-is-checking-me-out radar, I saw a pretty sorry one looking back at me. There was a little kid without any shoes with a sad little hand out in my direction. I looked at him for a minute while I thought about what to do. This was the first time I'd been asked for a handout in Mae Sot. It's a small town so the dynamic is different. In NY I almost always give money to the subway musicians, and occasionally to women, but you never know what it's going for so I don't feel great about doing it. I've read stories in the papers here, well, about war deserters, but also people being caught bringing little kids to Thailand from Cambodia to beg for money for their parents or kidnappers. When the minute was up, I gave him a packet of seaweed rice crackers I had in my bag. It wasn't what he was expecting but he took it and went away without saying thank you.

After another minute I wrinkled up my nose thinking, not about fictitious WMDs and an illegal war that perhaps someone should be impeached over, but about my own misstep that I was regretting, but perhaps could rectify. Sure enough, a few minutes later the kid was back asking for a handout from a table of gem traders who were ignoring him. I caught his eye, motioned him over.

The hand motion for calling someone to you in Asia different from what we use in the West. I picked this one up in Indonesia after a few comical communication lapses. "Come here" is a hand pointed downward and fingers moved back and forth. To a westerner it looks like the signal for flicking someone away with the back of the hand, but to them it is the fingers moving toward the palm part of the gesture that is important.

With an open palm I motioned my little friend to the seat opposite me, and to my plate, and to the menu. He was hesitantly checking me out but wasn't freaking out. The source of the hesitation became apparent when another little kid appeared seemingly out of the first one's back pocket. He stood there until I motioned him to the table too.

I wasn't sure if they would know what to do with the menu so I turned to the vegetarian pages from which I'd ordered to show them the pictures, but they confidently took the menu, skimmed through the choices, flipped the pages, and lit up when the waitress came over with the ice cream menus. I felt like a grouch directing them back to the first page we looked at, but I figured it was a good protocol to let them have what I was having. We ordered two more tofu & rice dishes, and sat there waiting for them for a long time.

I'm not sure what percentage of the town is Thai and what is Burmese, but it's a pretty good mix. There is a fair percentage of Muslim in town who, unlike the Indonesians, dress like Muslims, though there are very few serious head scarves. I have eaten some very tasty and unusual dishes in the Muslim restaurants. It's wonderful to be in my 30's, from New York where everyday the meal is of a different ethnicity, and still encounter tastes I have never had before. I don't mean new combinations, I mean entirely new flavors.

These kids were apparently Burmese, telling by the white-yellow paint all over their faces. This is something the Burmese do which seems part fashion, part sunscreen. Some women come into the clinic with solid squares (!) of the paint on their cheeks. Some children will have circles on their cheeks, a swirl in the middle of the forehead and a line down the nose. Some people will have a very thin coating of paint all over the face just barely visible on close inspection, and some will have the same but more heavily applied. In a way it does make them lighter-skinned, sometimes Geisha-like. Roughly half the women use the face paint, and a smaller percentage of the men. Perhaps on children it's sometimes for decoration but more for sunscreen, as the way these children had it thinly coated all over. The medics tell me it comes from a tree.

While we were waiting it occurred to me that I didn't know whether the non-English parts of the restaurant menu were Burmese or Thai. The two languages have different alphabets, both kind of swirly, with letters that look like c's and n's turned in all orientations with circles and lines and tails through and around and hanging off them. As with English, they come in lots of different fonts, so it's not easy to recognize the letters, something I don't pretend I can do (yet). Whatever the menu was the kids had glanced over it effortlessly, and while I was impressed that they could read so well, it made me wonder.

I hadn't finished my meal but felt it would have been rude to continue eating in front of them, so I waited until their food arrived. I started making faces at them at the expense of the slow waitstaff and they laughed a little but probably didn't get what I was doing. They yelled something over to the waitstaff, who yelled back, and it made me wonder if the little beggars weren't the children of employed parents who were watching all the proceedings of this charade. Maybe, maybe not, but they were getting a better school lunch than I ever had growing up, and we were all having a good time.

While we were waiting, the first kid took out a piece of gum and chewed it. I figured, what the heck if they ruin their appetites, and gave them each an Altoid. Doesn't anyone tell these kids not to accept small white pills from strangers? The kid also took the unopened packet of rice crackers I'd given him out of his pocket, and put it away again. The two of them swung their feet, moved around the napkin dispenser on the table, looked at me and the ceiling and each other and smiled and fidgeted a little. The funniest was when I pulled out my Burmese and said to them, "Jema namay Melle," my name is Melle, and they double-taked each other and me. Then they told me their names but I couldn't tell you now what they were.

I pushed my glass of water over to them to share and they drank a little, then I said, "Water, water," and they repeated it. I taped the glass and said, "Glass," and they said "glass". It took them no time to get glass of water. I made an inquisitive face and opened my palm to them and to the glass, and the first little kid got it without hesitation. He picked up the glass, swirled it around, and said [something in Burmese]. Then he tapped the glass and said [something else in Burmese]. Then he said [something else in Burmese] of [something in Burmese]".

I stayed long enough to make sure they got their food and quickly finish up my own.
As I made to pay and leave I said to my companions, "Thank you, jezu dimbah day, thank you," and they said "thank you." I left them with, "Duay yada win daba day," nice to meet you, but I didn't make them do the translation, because it truly had been.
- posted by melle @ 11:48 PM

 
I honestly don't know how people with jobs, marriages and children do it. Last fall when I was doing only odd jobs, and sitting in front of the internet trying to arrange this trip, I was completely overwhelmed and paid almost none of my bills on time. Not in a real job, I'd made it a project and a commitment to go out once a week to Long Island to visit my 92 & 95 year old grandparents, and bring along a tape recorder to gather some of those precious reckonings of family history. Sometimes I'd also see my parents, sometimes my brother and his family. Other days I'd go to physical therapy, a temp job, hang out with this one particular cute Canadian, or some other friends for dinner. There was a whole slew of birthdays in November and December. I hardly got anything done.

Now that I'm spending my days at the clinic, half of my late afternoons biking into the countryside to go running, my evenings reading project proposals and reports, I haven't finished any of the four books I was part-way through when I got here. I have one bill to pay once a month, and due to my living situation and the absence of hot pots for sale in Thailand, I go out to eat every dinner and most lunches. At least over dinner I can get through part of The Bangkok Post or The Nation ("Thailand's Independent Newspaper").

On my day at home on Friday I did add a project around the reports I was trying to make myself get through. I had bought a bottle of Elmer's glue the day before, and spent some time in the morning sealing up the mouldings around the ceiling and floor of my room. Since I'm going almost completely vegan, why not go whole-hog Buddhist and try to avoid killing too many of the little buggers too? I'm talking about the resident parade of ants that goes from the top to the bottom of the wall in the corner furthest from my bed. I check on them when I come home to see if they're in line, and if so generally leave them alone.

Some people have goldfish, I have ants. Some people have ant farms in glass boxes, I live in a room with glass louvred windows. When the parade was merely up and down the wall I lived and let live, but when some of them seemed to be straying off toward the window by the bed, I started taking precautions.

It's really hard to squirt Elmer's glue in a crevice where a wall meets a ceiling since the glue pools at the bottom of the bottle and out comes air when you squeeze. But I did manage to plug up lots of gaps kind of using the nozzel like a paintbrush. Since they had made new paths around the ant traps I'd placed a couple days before, I glued up all the holes except the ones on the far side of the traps so see if that would get them to go through them.

At first the ants seemed to be completely blocked out and I thought I'd won the battle. But by the end of they day they were back, along their old path, and passing under the traps. So I glued up the space under the traps. The ugly black plastic perforated boxes are now permanent fixtures in this room. I can't say the same for myself.
- posted by melle @ 1:41 AM

 
This writing assignment for the clinic director is causing me all sorts of ennui, such that I just didn't get out of bed this morning, choosing to stay in the Rapunzel room, read, and do battle with one elusive, aggressive mosquito. Nonetheless, I'm learning quite a bit about the clinic in the process.

The Mae Tao Clinic was begun in 1988 as a result of student protests against the oligarchical, oppressive regime in Rangoon, or Yangoon, capitol of Burma. Dr. Cynthia was finishing her medical studies there at the time, and fled with other students to Thailand. I don't know what her actual participation was, if any, in the actual protests. A generous Thai farmer donated a barn to the refugees, where the clinic was initially set up by Dr. Cynthia and another doctor to provide emergency medical relief to the fleeing protesters. The clinic received donations from twelve NGOs in the first three years of operation, and continues to receive support from a number of international sources. It is three miles from the border of Burma.

Last week I went with one of the medics to her quarters. Inside the converted barn near the clinic entrance, we walked along a dirt passage at ground level avoiding small, muddy puddles, and me stooped over to avoid a bump from low-flying rafters. We left our shoes outside the door to her room, two steps up but same level ceiling. Epo shares this room with three other medics. The room is divided between pairs of medics by a curtain. Epo rolled out the pair of sleeping mats for us to sit on and showed me photos from recent years, mostly within the region of Mae Sot (where the clinic is), some in refugee camps where she used to live, where her family still lives. There are posters on her wall of waterfalls, which she tells me she's never seen.

In most of the pictures she is smiling in front of a lake, in a field, by a building, standing by herself or with someone else. In one, she and another young woman are crouched next to suitcases, scarves on heads, unsmiling. This is one where they had been alerted that Thai authorities were coming and that they would have to move. There is a Thai-Australian woman who told me she routinely is summoned down to the Burma border to talk Thai authorities into releasing a medic who would otherwise be deported, handed over to the Burmese authorities who would surely punish them. I don't know what the situation captured in the photograph was, but the women look scared.

This particular medic seems perhaps more serious, less light-hearted than the others, but she is also more solid, speaks English well, and stood and talked with me for a good half hour the first time I met her. She has been a medic/midwife for four years and has attended 300-400 births, she told me. She was eager to discuss theories on episiotomies and other birth techniques.

In contrast to what I expected, the clinic is moderately well-equipped, but the medics are under-trained. I thought I would spend much of my time learning ancient Burmese massage techniques for relieving labor pain, herbs for easing headaches and PMS, seeing babies put immediately to breast after birth. In fact their birth techniques are quite medical. At the first birth I observed, the medic couldn't have gotten in any faster to cut a huge lateral episiotomy, one I fear could effect the nerves in the woman's legs. I put my hands to my face and without thinking, perhaps assuming I wouldn't be understood, muttered, "Oh, she doesn't need to cut that episiotomy, she's stretching so nicely, she's only 20, oh god and not so deep…" It took the medic four or five snips with dull scissors to make the cut. Nobody bothered to massage the woman's uterus to be sure it was firm so she wouldn't bleed out, so I did it. The newborn was put on a side table, wrapped up, weighed, and set again on the table unattended while the medic sewed up the incision. To her credit she did a nice repair job and I told her so. However, Inge the German midwife was right: Thais and Burmese are very sensitive about criticism and losing face, and once you criticize one you have lost her forever. Since I expressed horror at her decision-making the first time she ever saw me, this medic has only ever once acknowledged me when she accidentally met my eye and I said, "Ni la gae," Karen dialect for "good afternoon," which she chucklingly repeated as she turned away.

It's clear they've received their training through the medical establishment at the clinic, not from traditional healers or TBAs – "traditional birth attendants". TBA is actually a term commonly used in settings like this, but which is objected to by more holistic midwives in the States, as a midwife is a midwife is a midwife and should be respected as such and not downgraded because she doesn't have a master's degree. "Midwife" is a term almost not used at the clinic at all, as all the staff providing health services in all departments are called "medic". The medics began here probably most as teenagers and have learned from people who have learned from books, such as myself, Dan, the Canadian surgeons who this week are teaching how to do an amputation with a Leatherman, and the German 4th year medical students who probably didn't bargain that they'd be used mostly for teaching English.

I was curious to learn my first week here that they'd recently designated or hired a specific lactation consultant to work with the new mothers. It surprised me, as I reckoned that most women would have grown up seeing their younger siblings breast fed, given any help they needed by their sisters, mothers, grandmothers. That was where the refugee situation and the breakup of families has ruptured the normal route of information transmission, somebody (Inge?) explained to me with mournfully shaking head. The older sisters, aunts, may be off in refugee camps or back in Burma, or in jail for dissident activity or just for being Karen. The women have come to Thailand to work in the many factories in the border region, or to work as domestic help in Thai households, and may have little to no support in motherhood. Sometimes the baby-fathers are even away elsewhere in Thailand or Burma. Those are the reasons a professional would need to be employed to teach something that normally would be virtually innate knowledge. At the very least Nestle is no longer providing "free" baby formula to poor mothers in developing countries for just long enough for their breast milk to dry up.

Back in the L&D (labor & delivery) department, my effort to revise the Board, the dry-erase blackboard where updates are written regarding laboring women's status, has gone well. While they neglect to write in the gravity and parity (how many pregnancies/births), they do now note time of last exam, cervical dilation, fetal heart rate, and presentation (head down, breech), and occasionally abdominal sizing and presumed weeks of gestation. Dan has lead an effort to organize the staffing into those attending to non-pregnant women (gyn. problems, post-partum) and those monitoring laboring women. The latter group would learn the guidelines about frequently checking the fetal heart (hourly in early labor, every 15 minutes in second stage just before giving birth). This following a fetal death in labor that I described in an earlier blog entry.

The bee, one of the bees, I've gotten in my bonnet is about dating the pregnancy – figuring out the due date at the very first antenatal visit. The earlier you do this in a pregnancy the more accurate it is, because fetuses begin to grow at varying rates later on due to genetic variation and environmental factors such as nutrition. They're all about the same size under 12-14 weeks, so if you can figure this out from the start, you know that later on a fetus that is small for dates may have a problem. All fetuses should ideally gestate for 37-42 weeks, with the standard median being 40 weeks. Typically when a woman's abdomen was showing small for dates, weeks were added on. I saw lots of charts that read 30 weeks, 34 wks, 38 wks, 36 wks. For the dating procedures they normally employ, with many LMPs recorded as "not sure", while casual and amateurish, the changes probably reflected somewhat accurate corrections.

I spoke to a good number of the medics individually, showing them the handy chart I had put together of pregnancy symptoms and when they typically occur in pregnancy, to try to calculate an accurate due date on the first due date, and why this is important. In the course of this crusade nobody asked me why this is important, or how it would effect the care they give. Of course Dan and I know why this is important, but it seems strange. In New York it feels like midwives are constantly at battle with doctors NOT to induce a pregnancy (cause a woman to go into labor, medically) as many doctors prefer inducing on the due date (40 wks) for legal reasons, while midwives follow the guidelines from studies that show it's safe to wait until 42 weeks, giving adequate fetal monitoring and all the routine precautions against decreased fetal movement. But here a large point of knowing an accurate due date would be to know whether to induce a pregnancy, either for passing a due date or in case of a medical condition (e.g. preeclampsia) where it's best to end the pregnancy as soon as possible.

Yesterday I taught my first-ever seminar on this subject to a group of 25 medics. It was fun, and I can see why people like to teach. Translation was provided for me by a medic who wasn't named "Tindah", as I'd gathered through Dan's Australian accent, but "Tender". Tender and I made lots of diagrams and charts on the dry-erase board, but I’m not sure with their level of education that the medics understand the concept of a graph that shows size vs. dates, for example. They could better understand the drawing of a woman's belly with the uterus at different sizes between the pubic bone and belly button, and a breast with the Montgomery tubercle sweat gland spots in a ring constellation around a pregnant woman's areolae that become apparent at six weeks. Dan and I had puzzled at the notation that the primary areola that develops at 12 weeks and the secondary areola at 20 weeks, neither of us having any idea what the difference was. I looked it up on the internet and found only that the secondary develops around the primary, which is kind of obvious. When the class called me on it, I bluffed sheepishly with what would soon become a mantra, that they would have to examine 20 women before they would be able to tell the difference. It was hard to keep a straight face when I shot a look at Dan sitting off to the side, who was cracking up.

Many of the items on the list, in explanation became clear that they would not be useful in a hard calculation of dates. Morning sickness: Inge says 8 weeks, the book says 4 weeks, I have found at 6 weeks, before which women rarely present to a clinic. Ballotment, the technique of bobbing a fetus up in the mother's abdomen (16-30) weeks is kind of a neat trick that I've only ever done once. But on top of the more definitive tests (fetal movement @16-20 wks, fetal heart with doppler @ 12 wks, FH by stethoscope @20 wks, bimanual vaginal sizing of uterus 6-14 wks), I included the other symptoms just to get them thinking about paying attention to the changes a body undergoes in pregnancy, and talking about them with the women. I underscored several times that the role of a medic is largely to learn and teach. The women would go back to their sisters and friends with better information to dispel the myths.

The one-page chart took two hours to explain, with translation and questions at the end. During the first hour they listened and took notes, but in the second when I started asking if there were questions, I got a lot of, "We don't ask that, we don’t examine that." I assured them I would be around for the next few months to show them how to examine that, and got lots of giggles. They don't examine the breasts at all they said, oh except sometimes and they show the woman how to pull out her nipples during pregnancy to ensure she'd be able to breast feed, well ok sometimes we examine if she's not too shy. The last item on the list I threw in for good measure in case they eventually ever do do Pap smears or tests for STIs as we do on the first visit in the States, though now they would never look for it without routine speculum exams, which nobody knows how to do. I told them the vaginal walls become bluish at eight weeks due to increased venous blood in the pelvis. The one male medic present asked a question in Karen dialect and turned very red in the face at the uproarious laughter it produced. Tender's hysterical response was, "Blah blah blah blah blah PINK!" And then cryptically, "Blah blah blah blah blah BLACK!"

When I see the medics interviewing women, taking their blood pressure, drawing blood, I see professional individuals doing a job well. They get the work done, joke with one another, hang out around the communal work table between patients, sometimes sigh from fatigue, usually have a comfortable smile and eye contact for anyone who comes into the clinic. They seem largely to be in their 20s, and in the RH (Reproductive Health) section mostly women but not all, and unmarried, mostly but not all. In contrast to during my travels in Indonesia, I have almost never been asked if I am married or if I have children. Most of the medics don’t either.

When I am standing in the hallway of the clinic talking with a medic, anyone wanting to pass by will squeeze between one of us and the wall, rather than walk between us. The patients, in addition to squeezing, will duck low unobtrusively. The medics don't do this. At least, the ones who speak English don't.

It seems natural that people who live and work in the clinic would be more at ease than patients visiting for a short time, but the difference in demeanor between medics and patients, all Burmese refugees, is more stark. The medics are professionals in a vocation, doing important work, becoming more educated every day, seeing positive results of their efforts. The men and women treat one another respectfully. It's clear that they thrive having this work to do. They are given housing at four to a room and get a stipend of 800 baht per month (US$20). But they are in a relatively protected environment in positions of prestige.

The patients on the other hand often have downcast eyes and don't talk much. True, nobody likes to be in hospital. And I could be projecting my assumptions about people illegally in a foreign country who work in factories or as domestic help, or who have sneaked through woods and paid a fisherman to cross the Mae Nam Moei river to come from a poor country with a hostile government. But I think there is a universal lesson here about human nature, how responsibility and a respectful work environment is a life-enriching experience.

In just the past couple of years the clinic received large enough grants to build some new buildings. The dark, damp rooms in the barn where Epo and the other medics now live is where the RH IPD (in-patient department) used to be. Now there are separate buildings with solid plaster walls for the medical IPD, RH IPD, and RH and medical OPDs (out-patient).

When I ride my bike to the clinic, I first pass through a throng of motorbike taxis hanging around under canopies on either side of the clinic entrance, drinking at a communal table or napping in a couple of hammocks that are part of the permanent furniture. It's a rocky steep entryway down into the clinic grounds, and though it's short sometimes I have trouble getting to the top when I leave, to the amusement of the taxi guys. Half the time they offer me a ride, even though I'm clearly on a bike.

Just inside the clinic entrance off to the right there is a kiosk where I bought a pink washcloth my first week, then a woman perpetually stirring a wok at a food stall where I have never eaten. To the left is the barn where the medics live. Further in on the right is a long one-story, white plaster building. In order they house Dr. Cynthia's and the administration's offices, the information and paging booth, a child play area, a roomful of broken computers and one that works, the library with books lining the walls and tables in the middle where meetings are held, and several large classrooms.

Off to the left beyond the medic housing is where the clinics are. There is a large outdoor area covered with tin roofing where people wait, watching a tv, to go to the OPD. There is often a guy selling clean but heavily used chemises in this area, often to be seen napping in a pile of them. Behind the OPD is the RH OPD, where I spend half of my time at the clinic. This is where women come for family planning and antepartal visits. The medics sit around a large rectangular table in the front of the room, where they review charts, do preliminary interviews with patients and take their blood pressure. The women wait in five rows of joined chairs.

There are two examining tables in each of the three interview rooms. The walls between the rooms are solid plaster but stop about a foot from the ceiling. Here the women have their abdomen's measured and their fetal hearts listened to. In the few times when the medics have appealed to me for help and I've decided she needed a speculum exam, we've taken her to another room in back, which is often locked, where there is one table, a sink, two stacks of chairs and a cabinet with books and supplies. The exam table is just a wood table covered with linoleum, no stirrups. There are big windows with screens and glass louvres, and one time while we were interviewing a patient, she kept waving back and forth with a grandmotherly type who was peering in the window. The medic didn't mind so we just carried on.

Mostly they invite me in to see cases that we end up referring to Dan anyhow – abscesses to be lanced, abdominal and pelvic masses, incomplete abortions (retained miscarriages). But since I've been hanging around more, they've been inviting me in more to see healthy pregnant women too. It's really hard for me to sit around the medics table and not get bored out of my mind while I wait for them to invite me in, but I don't want to push myself on them. If I read a textbook then they completely ignore me, so I usually pick up charts that are lying around and see if they've bothered to write an LMP. "Kle LO bi laaaah?" is "Is the baby moving today?" and I've taken to asking every woman who is obviously pregnant, which at least so far the medics think is funny. The correct answer is "hockeh", which I'm sure they'll tell me whether it is or not.
- posted by melle @ 2:29 AM

 
Earlier this week, Dr. Cynthia brought me back to her living quarters, in another part of the clinic where number of young people looking around 20 were taking care of a host of small children on grass mats in a wide hallway, under an array of photo portraits of the king and queen of Thailand, Aung San Suu Kyi, and Dr. Cynthia herself. We sat on grass mats as she explained to me that there were a number of quality control projects going on at the clinic, sponsored by different NGOs, which were aimed simultaneously at evaluating the physical state of the clinic and its supplies, the disposition of the staff, and the interface with the patient population; and then to use the evaluation for implementing improvements. She gave me some old reports to read before I would meet with her again.

For a woman who has meetings all day long and never a minute to spare, she is remarkably gentle, focused, and calming to be around. At the same time she is an awesome person who evokes in people the desire to please and impress. It wasn't clear to me exactly what she wanted me to write, and it still isn't. I tried to repeat what my assignment was but must not have hit the nail on the head as, though she said, Yes, I still didn't really get what I myself had said.

While I've done medical research writing in the past, it was a long time ago, and technical writing is entirely different from prose. The aim is to be very boring and very clear. The reports I read succeeded in the former, but I had to read them each over three or four times before I really understood what accomplishments and conclusions they were trying to communicate.

I was a little bummed out to get this assignment, as I'd been hoping to discuss with Dr. Cynthia my own list of clinical improvements I'd like to work on. She premised this meeting about the paper with, "Since they don't really need you in the clinic, do they?" But since Inge, the German midwife who has come annually for 13 years, got here this week, perhaps there are too many cooks at this one pot and it would be better if there weren't so many Western do-gooders doing similar things at once.

However, I did run some of my list past Dr. Cynthia. She confirmed that the water from the taps in the basins next to the "toilets" was used only for flushing, but that there would be a problem with people taking the bars of soap. When I mentioned that Pap smears have been shown to be very cost-effective, and that STI's (sexually transmitted infections) were never screened for but only treated symptomatically (while some never show symptoms except that the woman is infertile), she pointed to the problems of dealing with a migrant population for whom travel is difficult, expensive and dangerous; and the obstacles for follow-up. I didn't say so at the time, but some women giving birth here have had as many as five ante-natal visits. Dan said the problem with doing Paps is the prohibitive cost of treatment. I'm sure it's some of both. I've written a number of emails this week to midwives I made contact with last fall who have done international work, to ask for advice.

I've spent a number of hours over the past three days waiting outside the door of Dr. Cynthia's office for a follow-up meeting about the writing project, but she hasn't had time to see me again. Meanwhile, I wrote up a comprehensive checklist of the signs and symptoms of pregnancy, at how many weeks' gestation they occur, and a place for the medic to note when and whether a woman has experienced them, and whether the medic notes them on the initial ante-natal visit. I tried to show it to Inge but she averted her eyes to my masterpiece of style and content, instead impressing upon me the dangers of throwing too much paper at them, expecting them to want to learn from me, the perils of a Burmese "losing face", etc. Meanwhile, the medics have practically been dragging me in to see their patients with them, so I'm not too worried.

I showed it to Dan, who is supportive of my plan to calculate more accurate due dates on initial visits. During his weekly teachings with the medics he reviewed ways to help the women remember their LMPs (first day of last menstrual period, not last day, not date of first missed period; was it during a festival, holiday, full moon…). Then he reintroduced me to the staff, said I had some relevant ante-natal info, and would I do a teaching on it next week? I must remember not to have afternoon coffee the day of teaching my first class.
- posted by melle @ 10:33 PM

 
Perhaps the most woeful of my woes occurs when I have the misfortune to bike home behind the slow-moving ice cream truck-scooter. Even in Brooklyn at least I can't hear the repetitive, out-of-key carols from the bedroom. The jingle of this one is in (can't remember how to write this) 12:16 time, which means it sounds incomplete, like it's missing a measure. When I'm already having trouble falling asleep, and it gets in my head, it is most tormenting.

Happily I had another kind of bike ride home today. Sometimes through the haze I can see mountains in the distance, other times not. Today it became apparent that there are in fact mountains all around, on all sides. Mae Sot must be in some kind of plateau contained within the mountain range. The terrain is so, so flat, it must have been a lake bed or something, a long, long time ago.

As I approach town I always look for the guy with the sugar cane stalks, where I saw him the first time, but I haven't seen him since. He's got some kind of contraption, presumably for pressing the canes for cane juice. Maybe next time I'll get one, but last time I just bought the stalk and took it home, peeled it and ate it. They're actually pre-peeled which is great because the peel of sugar cane is very hard, and perilous to remove as it must be done with a folding blade Swiss army knife with a very short, very sharp blade. It's a lot easier to remove the dry outer layer of fibers than the peel. I consider it a great treat, something I'm gleeful when I stumble upon a bodega selling it on the Upper West Side, or a cart in Mae Sot. Must be genetic memory, my being half Hawaiian (mom's side). Maybe I'll see if I can find some in the market today at dusk.
- posted by melle @ 10:26 PM

 
Had a rough night's sleep last night. This is quite the raucous household. I was trying to read myself to sleep with some very dry annual reports of mediocre writing quality, which Dr. Cynthia had given me to read in preparation, possibly, to have me write this year's report. Out in the hall a man was saying, "Mina, Mina, Mina, Mina," maybe twenty times, then he knocked on my door. It was the guy staying in the room across the hall, a Thai from Bangkok, who apparently thought he'd been calling my name.

The night before he'd shown me a couple dozen pictures on his laptop of wooden human-size sculptures of creatures, animals, warriors, Buddhas, scenes from stories. I perked up at the Makam, From China, he said, which probably isn't inaccurate as Makams originate in Tibet. It's a creature from folklore that is part dragon (from China), part elephant (from India), and they're found in a lot of Himilayan artwork. This guy said he was receiving a shipment of these sculptures from Myanmar the next day, for export to Japan and USA. He offered to sell me the Makam for US$10,000. I laughed and excused myself to go to bed.

But before I could get away he asked me for some water because his girlfriend, asleep in his room, was hungry. It seemed a little odd as the patron had just shown them to the room and besides, who travels without a bottle of water in a country like this? I still use the mantra Mark taught me years ago, whenever leaving the house: keys-money-water. Ok that's not exactly how he taught it to me, and it changes to suit my needs: keys-money-glasses, keys-money-book/sunscreen/earplugs/etc. Anyhow I escaped after giving him my last half liter.

Last night he told me he'd lost the key to his room. Bleary-eyed and bewildered, I didn't know what he expected me to do, so I suggested he wake the patron, as it is the job of the patron to see that the guests are happy and housed. He told me he'd tried, that the patron was asleep. He said he'd just returned just now from Myanmar, and frankly seemed a little frantic. It couldn't have been that he'd been calling, "Mina, Mina," to the sleeping girlfriend, because the door was locked with a padlock on the outside. And where was she? Did he trade her to some Burmese for sculptures? The night before he'd said the shipment would be coming from Myanmar but that he wouldn't be going there himself, but then said he'd just gotten back from there. Moreover, Buddha sculptures are illegal and nearly impossible to export from Thailand. The whole thing was a little strange and I was eager to excuse myself again, after impressing upon him that he could either sleep on the floor in the hallway, wake the patron for a key, or try the guest house down the street. It wasn't clear that he'd even arranged with the guest house to stay another night, which might explain why he didn't have a key. Maybe I could have pulled a McGyver with my mini-leatherman and picked the lock for him.

A few minutes later there began a steadily increasing bout of yelling for, "Moran… MORAN…MORAN!!!" by a woman out in the yard. I cursed the bonehead who didn't have a key, as this was surely on his behalf. It reminded me of comedian Margaret Cho's rendition of her Korean mother with impulse-control problems yelling her Korean name. This went on for twenty minutes.

Then there was a baby crying and some low to moderate whispering after that for a while, and just as I was managing to drift off, a perplexing round of a woman in distress came in such a bizarre pattern that I couldn't imagine what could have caused it. It was a sustained cry of genuine fear and panic, followed by several minutes of weeping that sounded both of relief and sorrow. It was as if at first she couldn't get the tarantula off her back, but when she did it was still proof that the neighbor's angry curse on her was still in effect.

Over breakfast I commented to the amiable Burmese 20-yr-old who runs the place that there had been a lot going on last night. He laughed and told me that he had come into the yard through a dark doorway with his arms raised, because he was stretching. The woman, who had been out in the yard comforting her crying child had seen him and taken him for a ghost. This was a real possibility for her, apparently, as it had truly terrified her. As if being a refugee weren't already hard enough.
- posted by melle @ 8:28 PM

 
Another item I am thrilled I packed, which will free up room in the backpack when I leave it behind, is my bike helmet – kindly donated last year by Courtney when last one was stolen, and now held together by medical tape and decorated with stickers of hearts and pandas. The two main drags in town are parallel and one-way in opposite directions, so I sometimes forget to move over to the left side when they rejoin, to bike with traffic, contrary British-style. When hitting the road it's helpful to remember the mantra Tim taught me in Australia: Peril on the Right. Like in London when they paint "Look Right " on the crosswalks, for tourists.

There are technical problems with the bike I'm using, as things keep falling off of it and I'll probably have to get a new rear inner tube soon as this one seems to leak slowly. There are a few other bicycles on the road, but this is motorbike culture. I've never seen more than four people on one, but four's not unusual. Walking around Ko Samet island three gals passed me on one at low speed and I made a gesture of flagging them down. They smiled and carried on, but five minutes later doubled back to ask if I wanted a lift with them. I couldn't believe they were serious, because I certainly hadn't been. That's when I taught myself to say It's a Joke, I like to walk (or, Joke! Like walk!)

Motorbikes certainly make more sense than cars in a culture where it won't rain for months at a time, and presumably distances traveled aren't that far. I don't know what fuel costs, but at least here it's got to be more than the cost of bottled water (at $0.09/L).
- posted by melle @ 5:41 PM

 
Melinda accurately called me on my claims, or hopes, of keeping my expenses under $5/day, but she's quite right that it's pretty hard to do. The room alone is about $2.50, and meals range from $0.50 to $2, with breakfast in the upper range due to the high price of coffee ($0.50-75, and when it's most often instant). A dinner where I splurge on a couple of dishes and a drink will be a budget-breaking $3. Internet cafes are about $0.60/hr, which adds me up at more than a month of connection at home. 5 is a nice round number, but $7/day is more realistic and I didn't even buy the gold butterfly stickers for my bike helmet.

With the exchange rate nearing 40 baht/$, it's easier to figure out prices in terms of adjusted cost of living to a Thai by dividing the price in baht by ten (i.e., four times the cost to me). For example, my 3000baht/month room is $75 to me, and a fair price at $300/month to a Thai. $2 instant coffee is still a rip-off, but 30 baht for a stir-fry rice-veggie-tofu dish is fair at $3 – the difference to a Big Mac and fries is, of course, priceless.
- posted by melle @ 10:35 PM

 
I did manage this morning to take a 20-minute bike ride north to that Wat (temple) I went to my first weekend here, do a 20-minute run, then bike home. It was Sunday and people were hanging out on their porches. It always feels funny running in a foreign country – I hate the big neon sign it puts over my head that says "foreigner" or "American" or "weirdo". I remind myself I probably have those whether I’m running or not. I ran past a large family sitting on one porch and as soon as the children saw me they started gleefully screaming, "Helloooo! I love you! I love you! Helloooo!" On my second pass by the house when they started up again, I shouted back, "You love me? Oh my god!" There were shrieks of laughter and a chorus of "I love you! Oh my god!" I wonder what channels these kids are getting through the satellite dishes on their thatched rooves, if what they learn is, "I love you! Oh my god!"
- posted by melle @ 3:28 PM