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Chasing Green Ghosts - Midwife in Thailand and Burma
Saturday, May 01, 2004
 
No postings for a month bc I've been in Myanmar for 2 wks where there is no internet and I didn't have my laptop. I don't want to do a slap-dash knock-up write-up, so I'll eventually go back to my longhand journals and immediately post-travel email and write about it. be patient.

Also, just added a few posts dating back to March 20 I think. Feedback is welcome. ultimel@yahoo.com
Monday, April 26, 2004
 
When I first got to Thailand and was wandering around, checking out Bangkok, I was amused to see signs on the hotel doorways declaring, "NO DURIENS". I knew about duriens because there is a traveling ultimate team based in Jakarta called Durien. At first I figured it was a place like somewhere in Connecticut; or perhaps a company, as Jakarta is one of the few Ultimate teams that gets corporate sponsoring (though sponsorship is becoming more common, raising moral issues for this sport with its roots in disorganization). The Duriens explained to me that a durien is a fruit that smells so foul, it is illegal to transport aboard airplanes. One whiff will fester in your nostril for days and ruin the meals between. I was amazed I'd never run into this fruit in Asia before, though perhaps thankful.

I had taken a photo of a sign reading "Ancient Ice Cream" in a market in Chiang Mai on my first escape from Mae Sot, and had been disappointed when I got home a reviewed the pictures and seen that one of the choices had been durien flavor. I'd heard that the smell of the durien is awful, but the taste is sweet and quite nice. I also wondered if taro flavor would have been nice too, or just glued the teeth together, since taro is what poi is made of, which is what Hawaiians use for building wood furniture.

I had a chance to try durien ice cream in Mandalay. In its frozen, milky form it has a sweet, tooty-fruity flavor, but then a bitter, stinky aftertaste like a cross between vomit and ammonia. At the clinic and Myanmar I'd had the opportunity to eat, and finish with relish, many dishes I would never consider ordering again. The concept of "liking" food had almost left my vernacular. Almost everything I put in my mouth would elicit a "hmm, interesting," and if it didn't taste dangerous or consist of pure animal flesh, I would most often finish it. While in Thai culture, I understood that it is considered eminently good manners to leave a few bites of food on the plate to demonstrate that you had eaten so much of your meal only because it was tasty and not because you were so hungry that you finished it all and are perhaps still hungry. I wasn't sure if it was the same in Myanmar, but it became almost a compulsion for me to finish any dish put in front of me. Because there was almost nothing I could say I ate with relish, if I didn't pledge beforehand in a vague, semi-binding way to finish my meals, there would be a chance I'd quit before the third bite. So down it all went.

My first failure was the durien ice cream in Mandalay. I got about halfway through and couldn't stand it anymore. Despite the beggar woman with the child on her back that I was refusing to acknowledge, I ordered a helping of strawberry ice cream to wash down the grave insult to my digestive system, and I was still belching ammonia durien fumes in the morning.

There is only one begger that I have seen in Mae Sot, and it is the healthy little boy who seems to have grown three inches since I got here, whom I treated to lunch on Valentine's Day; sometimes he has his friend in tow, but he's the leader when they're a pair. He comes and begs at the restaurants where Westerners eat, and often stands looking at me. I haven't given him anything since, and I have steadfastly refused to give to anyone while I'm eating. For starters, I think it's rude and aggressive and I don't like to be bothered when I'm eating, especially if I'm reading. But second, in bigger places like Mandalay you're a sitting duck while you're eating, and once you give to one woman with a baby on her back, you have to give to twenty because they're all around. I do give to women with children, as I have heard that most money to men goes to booze & drugs, but most money to women goes to feed the family. I also won't give to women with children late at night, as the little ones should be home sleeping. I suppose late is when Westerners are drunk and jolly and generous (if they're the type), but one needs to justify oneself somehow and one way is by making up little rules (but never saying never).

Back in Mae Sot, coming home the opposite direction from what I usually take past the jail, I noticed two things. First, before the Indiana Jones wooden footbridge, the yard that had been full of burned-up, rusted out pick-up trucks and cars (reminiscent of a yard in rural America) had been cleaned up. Second, there was a big dump truck parked in the yard of the neighbors next door to my house. It was one of those big ones you see at home hauling gravel for road construction. This one was full of… duriens.

As I entered the guest house yard I overheard another guest asking the husband of Kritsana, the lady who runs the g.h., if they could settle up her bill. His English is much shakier than Kritsana's, so the husband said, "Oh, oh, yes, my wife, uh…" as I passed by. I'd just seen Kritsana going into the neighbor's yard and said, "I think she's at the duriens," and he went scurrying off in the right direction. I guess would be hard for everyone not to know about a dump truck full of duriens living next door.

When I saw Kritsana later I commented that now I knew where she was getting her duriens. I had been smelling them as I passed the owner's house for the past week, but she said they had just come today. This family does seem to eat a lot of them. She invited me over to sit on the landing in teak steps leading up to her house, and offered me a fruit I'd never seen before. I was delighted as I am sometimes a little scared of new fruits around here. Never mind all the dire warnings about eating raw things and then only peeling it yourself while you stand on one foot and hum show tunes – there are duriens around here! There is something at the market this season that looks like a pretty durn close relative to a sea anemone: deep purple, with green and red tentacles. I've been stung by anemone, and the market ladies probably drink the tap water, so I haven't touched 'em yet.

Kritsana's 15 year old son was cruising around the driveway on his mountain bike, going along the path to the guest houses then back past where we were sitting, through his mother's garden and over the small mimosa plants, and finally coasted right into the lattice from which a few orchid plants were hanging. She clicked her tongue at him.

The fruit Kritsana offered me was a deep purple like the one in the market, but with a smooth skin, and about the size of a racquetball. It had a four-leafed green little cap. She squeezed it open, splitting the sides, revealing a hot pink inner padding of the peel were the white inside an orange rind would be, and six white morsels of fruit inside, organized like pieces of an orange. They are too tender to be pulled out with the fingers, so the eater must suck them out one by one. Kritsana's husband had come out of the house and looked over her shoulder and said, "Ahh, that's a good one." There were five small segments and one big one. The big one had a seed that was not to be consumed, while the small ones were seedless. The flavor was gently tangy and very sweet, lasting, but with an after-sensation rather than an aftertaste. The texture was very delicate and slippery, but dense with flavor; kind of the opposite of a watermelon.

The flavor and the presence of the pit reminded me of an orange colored fruit I once had in Italy that had some kind of slippery seed or pit that I was told to play around with in my mouth for a while after eating the edible part, just cause it felt good. I've found the seeds of the tamarind to be a little like that too, but smaller and more prone to slipping down the throat. At least, this one was a little bit like that, but I didn't want to gnaw off the the entire membrane off the seed in front of Kritsana. Eventually, in private, I would and would find that the seed is actually a bit hairy and not at all very pleasant to play around with in the mouth. I was advised to choose the smaller fruits at the market, as the segments are less likely to have seeds.

Kritsana told me that this mysterious fruit was called a mangosteen, and then she started laughing. She said that the name is a joke about foreigners (she doesn't call us farangs, and I have never seen anyone in her family spit). The real name of the fruit is mangook, with the "k" somewhat swallowed. Foreigners have trouble hearing the difference between mangook and mango. Indeed, when she first asked me if I'd tried it, I'd looked at the purple fruit through the opaque plastic bag and said, "What, those are mangos?" So she'd taken to calling them "mangosteen" for my benefit as she explained how to eat it.

The story is that a shopkeeper is trying to explain that it is a mangook to a foreigner, who just isn't getting it because it just doesn't look like a mango. The shopkeeper gets so frustrated, he stamps his foot angrily and cries, "Mangosteen!" Kritsana is laughing hysterically at this point, and so am I, though it feels a big like my dad's "No soap, radio" joke. I asked her, "What does steen mean?" It means foot, as in the angry foot stamping on the ground. I gather that the foreigner's name for the fruit is thus something on the order of "Mango-damn it!"

It suddenly dawned on me that I could actually buy some of the weird fruits at the market and bring them home to share with Kritsana, who could show me how to eat them. If I had picked up the mangooksteens and tried eating them myself, I would have discarded the slimy white things inside and tried to eat the bright red lining of the peel, which I could tell was quite bitter just from incidental contact while sucking out the sweet insides. Kritsana laughed when I suggested I might like her help in eating some of the fruit from the market. She said the sea anemone fruit was just like the mangook, you just had to slice it open with a knife. She might understand if I put it this way: "I'm a little bit scared of the durien. Perhaps you can show me how to prepare so that I am not afraid to eat it?" I had a date the next morning at 8am, for breakfast with a durien. What a way to start a Saturday.
Sunday, April 25, 2004
 
Just before I left for Chiang Mai last weekend, I had drinks with Dan and Jane and Yvonne, in honor of the latter's next-day departing to return to Australia to pursue a PhD, I think in public health. She plans to take the next 12 months to do it, then return to Mae Sot. Bravo to her, mother of three (youngest age of 18), running off to work in Thailand, then going for a doctorate at age 52.

There was a new face at that table - Jo, an Australian MD who'd just arrived. She's in the same boat as I, volunteering under the auspices of no organization. She plans to stay 6 months to a year - only she's more likely to stick it out as she's done this before in India. Lucky dog. She did Royal Flying Doctors in Australia. (don't ask me, I haven't found out much about it yet except that it wasn't always flying about to this call or that; she would be called to a remote location and flown in for a week or two or so and see lots of patients then go somewhere else or back to base.)

This week we've had a whole lot of births. Some I've come in at the very last moment and gotten to pull the baby's shoulders out in the right direction (how hard can it be to remember to pull DOWN to free the top shoulder, then immediately UP to free the bottom one so it doesn't split open the perineum??), but others have taken more work. The medics told me one gal was 7cms. but hadn't been checked in an hour, so when I did I found that the cervix was completely gone (good) on one side of the fetal head, but enormously swollen on the other (bad). such a cervix is loath to reduce (dilate, pull back behind the fetal head) on its own since it's so fat, and trapped between the head and the pelvic structures. The ideal thing would be to lie the mother on the opposite side to take pressure off the cervix, but in this case the fetal head was so low it was pressing on the mother's rectum, giving her the uncontrollable urge to keep pushing. So pulling teeth, I got the medics to teach the mother how to pant (to reduce the force of the contractions) while I tried to work the swollen half of the cervix behind the head. Poor girl, I had to keep my fingers in for three or four contractions to make sure the cervix stayed back. It worked fine and it was a lovely birth in the end.

It's amazing how I see every delivery mistake at least once. A common one I have seen a lot is as the baby's upper shoulder appears under the pubic bone, the medics try to fish out the arm by hooking the baby under the armpit. This is a HUGE no-no, as it can rupture some nerves or ligaments and give the baby a limp arm. Besides, such a move is totally unnecessary. Once the shoulder appears, you pull the kid the other way (up) and free the lower shoulder, then you're home free.

I have decided that the only way I'm going to get them to do births correctly is to be there with my gloves on for every birth I can, and that they'll see what I'm doing and I can give gentle nudges and corrections. Half the time when they see me with my gloves on, they take theirs off and walk away. I have taken to asking which of the spectating bunch will be doing the birth, then pull her aside for a little tutorial. There is a rubber baby doll that has had a black beard and red devil horns inked on, which I use for demonstrations on when to pull up or pinch or press down or turn. This way, the medic knows (as far as she understands, or can remember) what I expect. In the actual birth, we are both there with hands on, and I have found the four-handed method to be remarkably good, one I will have to keep in mind for the future. Most birth attendants be they MDs or midwives do births single-handedly (that is, with their own two hands), and until I got involved here I did two. But with trying to teach these guys to coordinate the different times to pull the baby up or down, while alternately trying to protect the perineum or the urethra of the mother, it's been great having someone else focus on directing the baby up or down while I play defense for mom. I haven't had to do a single repair all week.

I got to the clinic at the same time as Jo on Tuesday and she asked if she could come see what my living arrangements were at my guest house in the afternoon, as she's having similar troubles to mine when I first got here. Same-same but different in the other direction - she's paying too much for too nice housing and not enough mosquitos in the bathroom. It was raining like the devil at the appointed meeting time, so I wasn't surprised that I had an uninterrupted afternoon to read about spies in Egypt. There have been a few sprinkles from 5:30 to 5:45pm, but nothing like this monsoon typhoon for three or four hours that left branches strewn about the neighborhood. Jo did catch up with me as I was headed to the reservoir the following day, and we had a nice bike ride together before I took off to go running. She had brought her nice mountain bike from Australia, but didn't bring any shorts, fancying she was headed to a prim part of the world where bare knees were unacceptable. I told her to come back to the parking lot of the police station next door to my house at 6pm, to see the ladies in spandex hot pants and sports bras doing aerobics to the house music version of the hokey pokey. I pointed her to a sports accessory shop in town. She worried she wouldn't be able to find any in her size, but from all the chubby Thais I've seen scooting around on their motorbikes, I didn't think she'd have any trouble. She's of normal girth, and a normal build like me with a height that puts her at slightly taller than average and towering over the average Thai, that shorts wouldn't be required to cover in any case. We've made plans to run on Sunday, which is nice in principle except that I've never really liked having a running partner. At least on the Hash, I could pick people up and drop them at will, and do most of the run solo. With just one other person you have to adjust your pace, never mind keep the date in the first place even if you ultimately don't feel like going running. I suppose I can give it a trial run just this once and see how it goes.

Today at the clinic we had four births in five hours. The first two took less than an hour each. The third I stepped in to for literally 30 seconds, to help them pick up the lower fetal shoulder up and over the perineum (come on, it's not that hard!), then went back to the birth I was working on. I only stepped in that minute as I'd just put on new gloves and decided to take a look to see who was behind the curtain (though I'm sure the medic in charge would have preferred I pay no attention).

The birth I'd been involved with had been of a 21 year old first time mother, with a Chinese-looking face and long, tragic eyelashes. She was there with the baby's father, and she was working really, really hard. Once a laboring mum is "fully dilated", she's reached what we call "second stage", and the time limit is accepted to be two hours, though in NY we generally scream them out in under 45 minutes ("Come on, hold your breath and PUSH, 1-2-3-4..."). There's really no rush so long as the fetal heart is going at a good rate (110-160 beats per minute), and both the fetal head and body need time to rotate and descend a lot. I've been teaching the medics that it's important to listen to fetal heart sounds every 15 minutes in 2nd stage, and recognize that if they're good, that waiting is preferable to doing an episiotomy. Sophia hasn't done a birth in the past month while I've been there, and now that I'm there with my gloves on and showing no mercy in the technique department, so there's been no resistance. I think they're pretty amazed that you can do a birth without an episiotomy or lots of nasty tearing.

So I let this one gal take a rest for the first hour of second stage, figuring most often the fetus descends fairly well on its own. We did a little more directive pushing starting in the second hour, without much effect. The new-ish medic who was to do the birth had long ago taken off her gloves, and now Poe was there with me, doing an impressive job of motivating the mother to push. With the clock ticking on toward two hours, I felt around the fetal head and was surprised that the mother seemed to have a lot of pelvic room but that the head was so stuck behind the pubic bone. Through the mother's belly it felt like the fetus' back was against the mother's back, which can cause a longer labor but shouldn't hold up a birth indefinitely.

I had the mother flip over so that her head was down and bum in the air, and tried to push the fetal head off the pubic bone, and rotate it into a better position. One possibility was that the cord was wrapped around the fetus and holding it back - a theory that seems unlikely when you think about, but we birth attendants agree from experience that tangled cords do seem to be present in many slow births. However, it was seeming more and more likely that the head had entered the pelvis in an awkward position and was just stuck. With the mother's belly hanging down, perhaps the shift in the weight of the fetus would give us room to maneuver. I pushed and prodded but the kid wouldn't budge.

Two hours and twenty minutes into 2nd stage, the fetal heart rate was up in the 170s with no decelerations, which is slightly faster than desirable but without a bad pattern. I wasn't terribly concerned, but I didn't think this birth was going anywhere. Dan and Jane are away in the islands this week, so I sent for Jo. I had seen Dan use the vacuum extractor once, but none of us present knew confidently how to work it. Jo look aghast at the 1950s oil rig-type contraption. With the fetal heart rate in the 180s now - a sign of stress - I for one felt the risks of trying the vacuum were less than those of an eight-hour second stage and the dead baby that might follow, and Jo agreed. It took three of us (me, Jo and Poe) about 15 minutes to put all the pieces together and figure out which pedals put on the suction and which let it off. Jo's plan was to apply the suction cap at a certain pressure until caput formed then increase the pressure, then either just rotate the head and see if the mother could do the rest, or just pull the baby out. I knew she was going for the second plan when she asked for lidocaine - local anesthetic, the humane practitioners precursor to an episiotomy. Unable to keep my mouth shut I warned, "You know, lidocaine causes swelling." Jo, the MD, gave me a kinder look than I deserved and said, "I know."

After a few minutes of fitting the suction cap on the fetal head and working the pressure pedals Jo turned to me and said, "I hope you're not terribly upset, but I think I need to give her an episiotomy."
"Oh, yes, I understand."
"I'd like to ask you to do it for me."
"Oh. Er. Alright."
I picked up the bandage scissors that have one flat, rounded end to protect the fetal head from getting poked, and made one determined cut at the perineum - and barely made a dent. They were as dull as a daytime soap. I tried the small, pointy ones, which were just as bad. It took me about four cuts, and I'm not sure I gave Jo much more room to maneuver, but she didn't ask me to cut anymore. The baby's head corkscrewed around as it came out, and the body easily followed. The heart rate was at 60 as Jo pumped air into the lungs with the ambu bag. Within a minute it was up to a comfortable 160. The little boy was crying and pink within minutes, weighed in at 2.88kg (6.3 lbs), and seemed to have a black eye. As usual, we laughed about his banana head, so moulded and stretched from the process. It looks horrible to parents who think their baby has two brains and it makes mothers cry, but a head that's been squeezed out of shape from a slow birth goes into a normal shape within a few days. Newborns are like rubber bands; this one's head had been turned around inside 135 degrees – just you try turning around and inspecting your own shoulder blades without a mirror! Yet his hands gripped strong and after a few minutes he looked like any newborn or banana.

I stood holding oxygen to the baby's face for the next hour and making sure he stayed conscious, advising the medics (again) that the baby should never sleep in the first hour. Many babies stop crying and spend the first hour looking around the world, checking things out, until they're put on the breast. This one had some menacing, pissed-off expressions that went well with the black eye. We got him to the breast as soon as Jo was finished stitching up the wretched epis. I would have to find a vitrier to sharpen those scissors.

That night, Jo found me at dinner where I was absorbed in Steinbeck's Of Mice and Men, which Jane had lent me. The curry on rice at this one place is safe to eat without looking (no dangerous little chilies plotting an ambush). She had a lime juice with me as she apologized for having me cut the episiotomy. I laughed that she has sought me out just for that, because I'm really not squeamish at all and hadn't minded doing it as it had been a necessary one. In fact, I was grateful for knowing definitively that the tools at hand were entirely unsuitable, and that elective episiotomies should be punished with tar and feathering. I had Saturday night plans for dinner with a Swedish couple and another friend of theirs, and invited Jo along. I thought it was so sweet that she came to find me to be sure I wasn't traumatized, and wasn't at all sappy about it. It's been nice to meet her, seeing there are other people out there in the world doing all the things I like to do, and with a similar temperament to mine. It's a pity she's female.
Saturday, March 20, 2004
 
Lately, a couple of the medics in the OPD have been taking me in to see their patients or asking me theoretical questions, or taking me up to the loft where the medics have lunch, but just as often I will sit at the common table where the medics write up their charts, and read through the charts finding incomplete or incomprehensible medic notes. I can't read who has seen each patient so sometimes I will ask the closest medic to me at the table what the story is with the patient. They'll explain a little of the patient history and the treatment rendered, and I'll say Ahh and nod understanding, then make a comment about an aspect of treatment that could have been added.

Dan has said that at times the OPD medics feel ignored, and that the classes he gives are targeted more to the IPD medics. The talk I managed to give on Friday, about mental preparation of the woman in pregnancy, contained information and ideas more relevant to the OPD medics. Before the lecture I stopped by the OPD to tell the medics as much, and to ask them to come to hear the talk at 3pm. I began the talk at 3:15, and one OPD medic was present.

My discussion of a person's natural associations with pain is good for the IPD medics to hear as well, as they are the ones in the vicinity while the woman is doubled up in the hallway with her second-stage contractions. They are the ones that can reinforce to the woman that although she is feeling this strong, uncomfortable sensation, it is not pain indicating bodily damage, such as when you break your arm or sprain your ankle. Or pop your ACL…

I don't generally use the popped ACL as an example, but it was my experience of this that fantastic trauma that helped me develop this theory of pain association. Back in 2000, I had lost 8lbs. I couldn't really afford to lose while traveling across Indonesia for two months. I was sitting on buses and boats a lot, occasionally climbing a volcano at sunrise, but not keeping up training and not running at all, and I lost a lot of muscle mass.

I usually design any escape from NY or return to it to pass through Paris so I can drop in on my sister who lives there, and to hang out with my little nieces so I know who they are as they grow up, and they know me too. I was living in Madrid when Louise, who is now six was born. Due to the ultimate tournament schedule, with Rimini over Easter, Portugal in June, and Barcelona in October, I have made it over to visit them twice a year, sometimes three times, since the advent of Lulu, and now Lili, too. When I am lucky enough to have the time, I will pass through Paris on the way there and on the way back, so we all get a double dose and are sufficiently sick of one another to hold us over for another few months. Rebecca and Cristo and the kids even make it to the States once or twice a year, so we're lucky to know each other quite well, for an intercontinental family.

The sequence of this return trip from Asia through Europe in 2000 I believe took me from a family visit in Paris to a tournament in Geneva, where I was honored to play with the Patatas Bravas of Barcelona, the best-natured group of ultimate players on the planet, with the biggest fan club. At any tournament at which they appear, it takes instants for a crowd of the members of their elite fan club (many erstwhile Bravas players, if only for a single tournament such as myself) to gather, and begin belting out raunchy songs in Spanish.

The Geneva tournament itself is nothing to sneeze at. The feeling amongst the teams out on the fields is of the highest level of Spirit with a capital "s" (which is ultimate-speak for sportsmanship). They always give an awesome prize that is worth the trip to the tourney just by itself, which players treasure for years. And then there is the party on the boat. The year I went the theme was In the Jungle, and Babs was dressed as a parrot. She and I had played at the same tournaments for years, and I wouldn't become friends with her for a couple of years yet, but her gorgeous green and yellow feathers made an impression that I will not soon be rid of.

This tournament was a sad turning point in my life. I hadn't realized how much muscle strength in my legs I'd lost over the prior months. So when I made a hard cut for a reaching pass from Rocky, I heard a snap in my knee and fell to the ground. Something definitely had happened inside that joint, and though it hurt, it probably didn't hurt anymore than an ordinary sprained ankle. Nevertheless, I rolled on the ground and screamed bloody murder for a minute or more.

On reflection, I'm sure it was less the pain than the terror of having done some serious damage to a joint that was notoriously difficult to treat. There was some pain, but I think my hollering was more a response to fear.

People in their ordinary lives experience pain when they burn themselves, when they fall and skin their knees, when they bang their heads on low-hanging cabinets. Usually pain indicates some degree of bodily damage. This isn't the case with labor pain. When the uterus contracts and the cervix opens up, as in the case of labor as well as menstrual cramps, it's the a time the body has the sensation of pain when there is no damage. Frankly, it feels like an evolutionary blunder that could have threatened the continuation of the species, were it not for the powers of sex. Still, most women aren't inclined to run off and hunt tigers in their 9th month, so the torment of labor really wasn't a necessary part of the package. Except perhaps to make kids less disposable, and parents less eager to exchange them for a better deal.

So I ran through a list of things that could possibly cause a woman fear regarding birth during her pregnancy. They included pain, death, death of someone they knew in childbirth, near-death themselves in a prior childbirth, loss of control, bad dreams, fear of attack by the SPDC while in labor, fear of being a parent, fear of a damaged or imperfect child, fear of not being able to perform the birth process, and not being able to breast feed the infant.

I focused on pain, as it was the most tangible, and has the greatest effect on the process of a labor. Pain-->fear, fear-->pain, fear-->tension-->holding back during birth-->slower labor, etc. Sophia translated for me. They didn't ask many questions. I think this was a highly-atypical lecture for these very medically-trained medics.
Wednesday, March 17, 2004
 
In case you haven't read it in a while, I am including below the family tree from Tolstoy's War and Peace, so you can keep all the characters straight.

SPDC – State Peace and Development Council, the military/political party that runs the Burmese government
SLORC – State Law and Order Restoration Council (founded after the 1988 Uprising), former name of SPDC, before a Washington-based public relations firm recommended a name-change (presumably to something that doesn't sound like a feasting beast)
KNU – Karen National Union, the military and political representatives of Christian Karens, currently still fighting the SPDC
KDBA – Karen Democratic Buddhist Association, representative of Buddhist Karens, which currently has a cease-fire truce with the SPDC
wat – Buddhist temple
farang – foreigner (from "French")
MTC – Mae Tao Clinic, where I don't work because I don't have a work visa
Dr. Cynthia – Director and patron saint of the Mae Tao Clinic, where I don't work
RH-OPD – Reproductive Health out-patient dept., for family planning, antenatal visits, etc.
RH-IPD – RH in-patient dept., where birthdays are made
Poe – my sardonic medic friend
Cheri – the medic who took a month to decide she liked me after all
Myo Myeh Ah – male medic I work with a lot, who may have to go back to Burma soon
Tindah – "lazy Buddhist" medic with a sharp sense of humor
No Tu – fervent Buddhist mother of three who chews beetle nut constantly
Sophia – highly competent medic who runs the RH-IPD
Sin-La – RH-OPD medic, who makes me feel useful by asking me questions
Nori – medic who runs the RH-OPD
Um Pan – Nori's sweetheart; Dr. Cynthia's administrative right-hand man
Mau Mau Tin –Burmese (non-Karen) artist who hangs out at the clinic
Dan – the Ozzie doc I work with, not to be confused with:
Bung Dan – the ultimate player I know from Bali
Jane – Dr. Dan's wife, who is about five months pregnant
Anna – nice, atypical NGO type, who is about eight months pregnant
LP - Lonely Planet guidebook, or phrasebook
BKK – Bangkok
GWB - George Washington Bridge, or Dubya, depending on context

I miss: peanut butter
I crave: macaroni and cheese
Tuesday, March 16, 2004
 
Most of the ex-pats in Mae Sot are here on tourist visas, as work visas are difficult to come by. Moreover, it appears that the decree stamped in my passport "Not eligible to work" is not vigorously pursued, to the benefit of all.

One-month tourist visas are issued upon arrival in Thailand, whether by plane or otherwise, to citizens of a couple dozen countries. The two-month tourist visa I had gotten at the Thai consulate in NYC before coming here had been just about as much trouble to get as it was worth. It gave me enough time to sound out the other ex-pats as far as what they did to renew theirs, as well as get all the necessary advice about how low a profile to keep in town, the police and political and military situations, etc.

I've had my fingers in too many pies at the clinic lately to think about taking that trip to Nepal this week. When my visa was to run out on Thursday, I decided to play it safe in case I was misinterpreting the dates, and take care of things on Wednesday. I gather it's possible to renew one's visa in Bangkok, but up here, people do it by leaving the country. We're 4 kilometers from Burma, so that's where people go.

I had spent Tuesday at home, editing my paper for Dr. Cynthia, and proof-reading and correcting another report written by Paw Ruth Say, a worker in the office, for grammar and clarity. This one took several hours to decipher and clean up and it was late by the time I was done. It's been wicked hot in recent days so I went swimming for a couple of hours in the late afternoon at the Mae Sot Hill Hotel pool, fifteen minutes east of town on the Asia Highway.

I stopped by the Clinic on my way to the border on Wednesday to print up and deliver the corrected papers, and heard from about six people that Dr. Cynthia had been asking after me. Dan told me she'd phoned him up the night before to go find me, and that he'd come looking for me at my guest house (when I'd been out swimming). When I found her and gave her the papers, she gave me another report to edit. This clinic should appreciate my years at private school. Anyone who has had a British tutor probably won't. Anyhow, I got wrapped up with a bunch of things and didn't make it to the border until the next day. I wish I'd realized the benefits of setting one's watch a day and fifteen minutes ahead while I was in school.

The ride to the Burma border from Mae Sot takes about a half hour. It's a long, straight, hot highway that passes the little local airport, and not much else. At the border, there are a bunch of shops selling polyester sarongs, shelacked furniture and over-priced Cokes. I biked around them to make sure I wasn't missing anything good, and perhaps to price compare in case I saw similar things on the Burma side. Nothing looked interesting except a guy sitting in the doorway of one of the shops. He waved hello to me as I biked by in such an aggressive manner, he was acting like he knew me. After a double-take, I realized it was the guy who had stayed in the room across the hall from me at the old guest house, the guy who had sold his girlfriend in Burma and tried to sell me a piece of old wood for $10,000. I didn't need to have a conversation with him so I acted like it was mistaken identity. It's possible he hadn't actually recognized me and just wanted to try to sell me another piece of old wood.

Thailand and Myanmar are separated by the Mae Nam Moei River, which is why, as I ultimately figured out, I should have had no fear on my long bike rides out of town of accidentally finding myself in Burma or having to explain myself to a border patrol. At the checkpoint on the Thai side, I handed my passport to the Thai immigration officials who checked the dates, stamped my exit, and ushered me toward the Thai-Myanmar Friendship Bridge.

I know you're not supposed to rankle customs and immigration officials, but it occurred to me for a moment that perhaps I didn't have to go to Burma, that I could just get the Thai stamps on this side. Maybe they figured I was a tourist wanting to visit Burma. I tried to ask a couple of different agents, but they didn't speak English and it was clear I was agitating them by not just going over the bridge the way I was expected to. I tried in broken Thai, "Mai yaak pai, mai ka," roughly "Not want go [question word] [polite word]." The officer understood, and steered me with his hand on my shoulder toward the bridge with a definitive, discussion-ending nod.

The regime changed the official name of the country, at least as far as the rest of the world is concerned, from Burma to Myanmar in 1989. Because of the despicable politics of this regime, the change has been recognized by some in the outside world, and others not. According to the Lonely Planet, Myanmar is the more traditional, and more egalitarian name for the country in any case, as texts dating back to Marco Polo's days in the 13th century refer to the greater country as Myamnar. This has been the name used within the country, while the rest of the world for over a century has referred to the country as Burma, the name used by the English colonialists who derived it from the Burman majority population. Our associations with whether to refer to the country as Burma or Myanmar are therefore ironic.

I walked over the bridge behind a gaggle of saffron-robed monks who had arrived at the Thai border in the back of a pickup truck at the same time as I had. As I tried to take a picture of them as they walked under a large sign over the footpath that read, "Preventing drugs is our national cause," my camera announced that my memory card was full. Aha, not foiled, as I switched cards for an empty one. Then my camera instructed me to change the battery. Oho, foiled. Alas, but oh well, I would need to return here in another month anyhow and would do so with a charged battery the next time.

On the Myanmar side, I was ushered into an air-conditioned room where I filled out a form, handed over my passport and 500B ($13), and waited for long enough to watch on the small tv a Thai music video depicting a teenage girl throwing her stuffed animals around and contemplating dropping a hairdryer into her bath water because a cute guy was ignoring her. What a novel way for a teen to commit suicide, I thought. You can learn so much from television.

The guy gave me a receipt for my passport and told me to be back by 6pm. He was the only one wearing a chemise and a sarong, amongst all the other men in green military garb, and I almost stopped one of the military guys to confirm that it was standard to leave one's passport, but chickened out. Leaving behind one's passport is the kind of thing that makes a traveler nervous and I was surprised none of the ex-pats had told me that that was part of the procedure.

Oddly, my first thought upon walking into the world of Burma was how this must be what Cuba is like. It had been on my mind weeks before, that the people of both countries were denied the liberty of free market enterprise, and were probably therefore very poor, but not mindlessly materialistic like the rest of the world.

The first noticeable difference from Thailand was that the majority of vehicles moving on the street were not motorbikes, but metal and wooden carts powered by a guy peddling the back half of a bicycle welded behind the cart. Several of them offered me a lift, but I had nowhere to go in a hurry so I chose to walk.

The same brands of soap, cigarettes and chips were hanging in all the shops as in Thailand, but there were more people sitting about in the wide, dirt "front lawn" areas between the sidewalks and the shops. I passed a group of men engaged in a heated match of checkers. This again, oddly, made me think of Cuba, where I have never been. Later it occurred to me that in Brooklyn, at least, men from Puerto Rico have heated Dominos matches, not checkers. Same idea.

People weren't hassling me at all and it was easy to lose the one guy who had tried to follow me over the bridge offering to be my guide. I felt oddly calm as I walked through the town. A temple with a golden stupa pagoda lured me off the main drag, and I went in and sat inside a room where a monk and a lay-woman sat meditating in front of a thirty-foot tall plaster statue of Buddha with brown lips and eyes and pink fingernails.

I don't exactly meditate, but I enjoyed sitting quietly for half an hour. When the wind blew the shutters open and closed on one side of the room, I enjoyed watching the light change, reflected on the thousands of tiny mirrors in a patterned mosaic on the walls and pillars around the room. I so enjoyed it, it made me smile as my senses were stroked by this visual music. I felt a little sorry for the meditating monk who was missing out on the dynamic aesthetics of this great room he was in.

My query for the day was whether the tenets of Buddhism, which encourage detachment, can square with passion? The Tibetan Buddhist monks I saw in NYC last summer making a sand painting over the course of ten days – knowing that their work would be dismantled soon after it was finished, were they totally detached from it? Did they have no aesthetic experience of it? Were they emotionless as they meticulously spooned out colored sand almost by the grain? What were they trying to show us New Yorkers who gathered round to watch them work, admiring their technique and this intricate piece their craft was producing? Did they expect us to learn from them not to care about it either, since they didn't? What is the value that has monks diligently working for days on something that will shortly be destroyed, instead of something just as impermanent but useful, like a carrot garden?

I guess I could learn something from them, as I do get upset when I break a piece of pottery I made, if I'm particularly fond of the piece. That is the point, I reckon, that time is relative, and that everything is impermanent. But it seems futile to be thinking about the loss and destruction of a thing while it's still being created. Don't you lose something – of art, of an experience, of love – if you are always prepared in advance for the loss of it? Kind of like never unpacking your emotional bags in a relationship. Does one suspend one's Buddhism to experience passion?

Feeling all tranquil and relaxed, I left the temple to head back toward the border, when I was drawn into a roadside open-aired café. It was a free-standing wooden lean-to-type building, with a raised wood platform floor, wooden tables and plastic chairs. There were thermoses of free hot tea on every table, as I had read about Burmese restaurants in a few books on Burma.

The tables were almost full. Despite a television showing a snowboarding competition with English commentary on ESPN (cable sports channel), there was a bit of a ruckus when I entered which I played up with jovial facial expressions and they found me a seat. We watched some really exciting flips in the air and some crash-landings, and I eventually realized that as many people in the café were watching the tv as were watching me as I winced or grinned as each of these athletes returned heavily to the earth.

Since beginning to play ultimate frisbee seriously in 1994, I have become a born-again sports enthusiast. For many years I repeated my father's adage, that I am a participant, not a spectator. I still say it sometimes when it's something that bores me like American football, but the truth is that people can do amazing things with their bodies, and I am easily impressed. Basketball players use a lot of the same moves as in ultimate, though we don't allow picks. Bernie Williams makes me whoop with delight every time he makes a layout catch in the outfield, especially since I only ever do that for a disc on sand or snow or mud anymore. And I don't need to sing Derek Jeter's praises.

Even though your average hack loser snowboarder specialized in scraping down the mountain with the board perpendicular to the trail, pushing precious loose snow off the ice and ruining it for those of us who know what we're doing out there, these guys on tv were giving a good show. I was less impressed by the motocross bikes going over the snow jumps that followed. To my tablemate in the café, I gestured to the bikes on tv and to the one parked in the lot next to the café, and he grinned and shook his head. I guess there's not enough snow in Burma for these tricks.

It wasn't until I was walking back to the border that I realized that the vehicles were riding on the right side of the road. Although there are lots of Burmese in Mae Sot, I don’t' think this accounts for why people walk to the right on sidewalks and in hallways in Thailand, because they do it in Bangkok, too. A heavy wind came up and blew off the straw hat of one of the cart peddlers. I ran and picked it up and gave it back to him, and he thanked me in English. It's a good thing I'm not French. Or worse, French Canadienne.

Before coming over the border, I had been referring to this area as Burma Disneyland. As tourists from Thailand can only come for the day, and therefore into a limited area of the country, I had expected that the Burmese gov. would have put on a good show of prosperity and civic accomplishment. However, there was litter everywhere, buildings featured flaking plaster facades and broken shutters, the sidewalks give a pedestrian a better work-out than a step aerobics class – but to be fair, the do in Thailand as well.

As I waited inside the air-conditioned customs booth for the return of my passport, I looked around at the Burmese border officials. It was hard to reconcile tales of oppression of ethnic minorities by men in these same uniforms, with the men who stood before me, to whom I had paid $13 for an exit stamp that would enable to get another month's Thai visa in a few minutes. They all looked pretty much like human beings to me. I guess G.W.Bush and I have that in common, that neither of us is necessarily a great judge of character from a single first-impression encounter in an official setting.

I didn't have to pay anything back on the Thai side, and got a visa from March 11 until April 9th, which I think is actually only 29 days, but I didn't argue the point.

On the ride home, I noticed a sign for a temple off to the north of the Asia Highway. The Lonely Planet mentions a long "path" to a temple on a hilltop, which I had as of yet been unable to find, despite hours of bike rides in what I thought was the right direction. I took the turn to the north and passed through some villages, somehow guessing right each time at several unmarked forks in the road.

I found myself on a paved but utterly barren country road. The LP had warned to confirm that the road was safe to travel before venturing out on it, as there were occasionally hostile interactions between the Thai and Burmese military in the area. I did pass by a couple of military post checkpoints, and at each asked how far it was to the Wat Phra That Doi Din Kiu (or, just to the Wat), and was waved through each time. The road follows a river much of the way, though there is no river indicated on the LP map. I'd be curious to know if this was the Moei and if that was Burma on the other side. I can see how this river would be tough to get across for a pregnant woman coming over to our clinic, but I saw lots of kids wading across at wide, shallow points under the bridge at the official border crossing. On this stretch of the road, the banks of whatever river or tributary this was were not obviously patrolled or guarded. It must be a peaceful time between Thailand and Burma.

After riding for about half an hour on an increasingly hilly terrain, I saw a sign in Roman letters on the right, so I turned in. It had the feeling of a State park back home, so I locked my bike to itself and wandered up the dirt driveway. In the clearing ahead there was a thirty-foot plaster Buddha, just like the ones I've seen in many wats, like the one in Burma. Behind the statue partially hidden by some ferns were stone steps leading up the hill into the woods.

It was perhaps a 20 minute climb until I came to a wooden lookout structure. I was about to enter it when a deep growl stopped me in my tracks. Inside, there was a mangy mutt and her two pups. Of all the nasty canines I've encountered in the country, this was the first time a nursing female dog had growled at me, but I was on her territory and she had these little pups to protect. Somehow thinking it would be very impolitic of me to blow my dog whistle, I backed up a little and sang a few bars of a Joni Mitchell tune. This gave me enough time to pull out a packet of seaweed rice crackers from my bag and toss them each one. When I saw the tails wagging, I knew it was safe to check out of the view.

The lookout faced west, over the river to Burma. In the area before the river, I could see a kind of day-glo orange sheet flapping in the wind, stretching across a row of trees in a field. Was it a construction site? After squinting for a few moments more I realized it was a brush fire. There is a lot of this going on in the area, to clear underbrush now in the dry season. As you may have read in the news, experts are now saying that the out-of-control interstate wildfires in the States these days happen because these small spot-fires are not allowed to take their natural course and keep the amount of underbrush under control. I've probably seen three dozen fires like this in the past month, some quite close to homes, and people sit nearby and chat. Nobody panics.

Past the dogs, the path split. I took the left path, thinking that if it made a loop, then I would be performing a proper Buddhist kora, hiking on a clockwise path. But it led to another look out, inhabited by a ten-foot high Buddha sculpture sitting cross-legged with a blissed-out expression. I sat and listened to the Buddha for a little while. It was then that I noticed the large boulder, precariously perched on a neighboring cliff to the north of the Buddha lookout. For the first time I wished I had batteries in my camera, but I could come back here the next time I was up for a long bike ride. I told my mother about it when she phoned and woke me up the next morning. She commented, "Oh, the kind of boulder Wylie Coyote likes to push over on the Roadrunner." My mom and I have whole conversations of profound cultural references like this.

On top of the boulder was a plaster obelisk, which I think they call a stupa. It had a metal top with a lot of little loose metal plates dangling from it, which made a delicate jingling in the wind. The wind was quite strong up on the hill, which was most welcome to me as we are currently moving from the merely-hot season into the really-freakin-hot season. I'm essentially a Northerner with a good sense of humor about the heat. It gets into the high 90's and sometimes over 100oF in NYC, but it's usually about 55oF in the subways and most shops (which crank the AC then leave their doors open).

Back down to the doggy leanto, I followed the other path with a sign reading "Buddha's footprint". There was a cement base painted yellow, built into another lookout point, with a stupa on top. I don’t know why it was called "Buddha's footprint". It was nothing like Hollywood Blvd. There was a bit of graffiti on one of the rocks: a small blue heart with a white border. As far as graffiti goes, it was cute.

The views off toward Burma were pretty hazy, but it was overall pretty flat, though I could see some hills in the far distance about as high as the one I was on. It looked like an expanse of wilderness as I couldn't see any signs of humans – towns nor buildings nor smokestacks. I can't really compare it to views I've ever contemplated in the past. In the States and in Europe, views like this are usually hillier or mountainous. I also have associations of brown, dry landscapes like this with autumn, and chilly, nippy air that makes me think of the prospects of new things at the start of the school year. This landscape and its atmosphere make me think of napping, moving as little as possible, an alien summertime hibernation. Like the first time you are served your salad after the main course in a restaurant in France. Or is it the other way around? I don't know if I have a "native" culture of my own anymore.

While up on top of the hill, I heard an echoing explosion. From what direction, I could not tell. I stood still for a moment, wondering what to do with this partial information my senses were perceiving. Of course, I could do nothing. I saw no new signs of smoke or flames. A minute later I forgot all about it.

On the way back down, I shared the rest of my rice crackers with the doggies. None of them had much fur. There couldn't be much for them to eat up here on top of this dry hill. I wonder if they were fur-less from malnutrition, or if that's mange. Is mange is a disease or a condition caused by malnutrition? Despite being hairless, the pups were pretty cute but I didn't pet them.

I was most of the way back down the hill when the two pups caught up with me. I told them I had no more crackers, but they didn't go away so I gave them each a couple of dried figs. I didn't think dogs liked fruit, but they must have been pretty hungry because they ate ravenously. I don't know how their systems will react to them but I won't be around to find out. Maybe they eat worse things, like two-day-old scraps of meat left as offerings at the spirit houses around the temple.

If this was the temple the LP had mentioned, then the road would continue north a ways past the wat, then curve around east then back south to Mae Sot. The road is hillier than where I usually ride, and my thumb kept reaching to flip to a lower gear, forgetting that I was on a gear-less, one-speed shore bike. It felt like I was going to break the pedals when I rode standing up, so I walked a bunch of hills. At home I feel like a pretty normal size gal, but towering over most of the local women and some of the men, I'm sure the nasty lady at the bike shop would blame me if I broke the bike.

I passed a few more military checkpoints, at each one stopping to ask how far to Mae Sot before they stopped me, so they wouldn't mistake me for a subversive Burmese illegal immigrant. I wasn't wearing my button-up chemise anymore because I was melting in the afternoon heat, and I think the poor young men isolated in these military barracks weren't quite sure how to handle this farang gal in the tank top. One of the checkpoints had a vicious, barking dog that they subdued when I stopped, but who chased me unremittingly down the hill as I sped away, undeterred even a little by my full-force whistle-blowing. Perhaps I should start carrying a bag full of rice crackers, too.

I rode along this rode for over an hour, not passing one single human being. It felt a little strange. Some of the land looked like it was cultivated in wetter seasons, but there were grassy and rocky stretches that looked untouched. The road was in very good condition, paved, with few potholes. I guess pavement can stay together when it never freezes. Lucky for cyclists, as surely they wouldn't get the same response here as we do at home when we spray-paint potholes, and send a record of their location to the NYC Dept. of Transportation (which then has about 14 days to fix them or be held liable for any accidents caused by them) and to the NY State Trial Lawyers Association. I admire the creativity of activists.

This ride was way longer that I had expected and I was pretty knackered by the time the road finally curved back south and I started hitting some isolated deposits of people again. I stopped at a stand and asked for naam, water. The guy at first ushered me toward the hawng naam, water room, but I eventually got my blessedly cold liter of water that I downed while watching teenagers play a game of football (soccer) on the dirt field across the road. A man in his 40s passed by me and said, "I love you, thank you," and kept walking before I had a chance to consider whether to respond or not.

It felt like 150oF, and I was musing about the merits of taking off my bike helmet. There was virtually no traffic on the road, I was going along at a snail's pace, and it would be nice to feel the wind in my hair. On the other hand, the helmet was white and reflecting the heat, keeping the sun off my head, and at any moment this bike could break apart at the joints and I could go flying. I could also space out and ride into a ditch or something. Much as I fear flying, sharks, and back injuries, I am statistically most likely to die in a biking accident, so I wear my helmet 99% of the time.

I hit a town that had some sharp left and right turns, and finally I recognized the place as the area I had explored the first weekend when I had rented the beater bike from No.4 Guest House for $0.75. This was a good sign. I had connected on the loop road, and as I was a little dizzy, it was good to know that I was not more than two hours now from Mae Sot. I recognized the two watch towers that had puzzled me when I'd first seen them, wondering if I weren't accidentally entering Burma before I realized that I'd have to have accidentally crossed a wide river to do that. I was now savvy to the presence of Thai military checkpoints, sometimes dormant, along their own border in case of Burmese incursions.

Passing familiar factories and schools, I hung a right at the Narnia wat, now 17 minutes (or 25, at this rate) from home. In the village under the tall blue watertower where children call out hello I love you to me, there was a crowd gathered on the side of the road. I saw broken pieces of scooter scattered on the pavement before I got close enough to see the young man lying on his back, one leg akimbo, eyes open and vacant, with a huge, 4" gash vertically up the middle of his forehead.

I rode past, not wanting to rubberneck, while my mind raced. What can a midwife do about a head trauma accident victim? I rode slowly and brainstormed, what CAN a midwife do? Finally it hit me, that a midwife can do CPR. I raced back, unbuckling my helmet, and was jumping off my bike just as an ambulance arrived. I was relieved, as was everyone else. Some of them nodded to me and pointed to the ambulance. We exchanged wan smiles and I rode on.

I had seen one other terrible traffic accident on the island of Java, Indonesia, the crash of a bus identical to the one we were riding in. As traffic was blocked, I'd gotten out to see what had happened and to see if I could help. I had motioned to them to put down the unconscious people on the ground so as not to aggravate any broken backs, but short of that didn't know what to do then either. I don't know why it took a second accident for me finally to extrapolate from the bicycle accident victims in the CPR videos to vehicle accident victims. I guess I associate CPR with heart attacks.

As I rode on, the "ambulance" passed me with siren blaring. From behind I could see it was a pickup truck with a canopy and flashing lights. There was a young man sitting in back, screaming desperately down into the truck bed. I cursed myself for not having thought of CPR immediately, thinking I might have afforded this young man a few doses of oxygen to his damaged brain, if he was indeed still alive at all. I don't know how much head trauma patients can benefit from CPR. The don't need heart compressions if it's still beating, and it'll probably only stop beating if they're actually dead. But then, perhaps the heart can keep beating while the breathing function is stopped. How often does that happen? It's so much nicer to attend births. Eventually I did give myself a break, knowing that if I'd stopped immediately, I couldn't have effectively brainstormed and come up with the CPR option while a dozen villagers stared at me, wondering what the heck this farang thinks she's doing. I guess a Buddhist learns not to beat herself up when things could have been done better the first time around.

Since people of the developing world seem so keen on adopting our dress, our eating habits, our use of technology, perhaps my wearing a helmet whenever I ride through town can be a good example of advanced, if paranoid, behavior. I cracked a bike helmet on a pickup truck in Canada when I was fourteen. I don't know that this is the part of the world where I want to be treated for a head injury.
Friday, March 12, 2004
 
When I mentioned to Poe that I needed to cross into Burma in order to renew my Thai visa, she offered to go with me. I had not considered this possibility and was thrilled at the opportunities it suggested: a Burmese guide, and a way to spend a day outside of the clinic with my new friend. She would check with Om Pan, the long-haired guy in the administrative office, to see what paperwork she would need to be able to cross the border. It had been my impression that medics could only go back and forth on the border by hiring fishing boats and taking illegal back routes, and that border authorities were to be avoided at all costs.

We flagged down Om Pan as he walked by just then and asked him about it, but he strongly discouraged the idea. Poe could easily get some sort of fake document to cross over, but if a foreigner and a Burmese were to cross together, or even be seen too much together on the other side, questions would be asked and we could both get in trouble. He firmly recommended I make the trip over by myself. So much for grand plans.

The political situation in Burma is still very confusing to me. While I'm told that it is safe to cross over the border into the towns just down the road from Mae Sot, it is also a "hot" area with continual fighting between the KNU and the SPDC. While the border crossing is under the control of the SPDC, this area of the country is KNU controlled.

As part of the paper for Dr. Cynthia I asked some of the medics what governing authority would prosecute and punish a Karen criminal, say, a rapist. This could greatly influence whether a community would be vigilant in capturing and turning over a criminal to the authorities, whether the authorities are seen to be on your side, or enemies themselves. The OPD medics said it would be the KNU, the IPD medics said it would be the SPDC. The OPD medics seemed to think there were whole areas controlled by the KNU inside Burma, while the IPD medics said the SPDC presence was ubiquitous.

Poe has reinforced my impression that the Karens are in a situation parallel to that of the Kurds in Iraq. They are demanding independence from the Burma government, to be their own governing body, and are using their own military to assert this will. The SPDC does not want to lose control of the land or allow the independence of this ethnic minority.

Thomas Friedman, NY Times editorialist, has written about how there is no "Iraqi" identity, how fractured the national identity is, how much more strongly each group identifies with their own ethnic and/or religious identity, than with being "Iraqi". In contrast, there is a definitive Iranian national identity, and there is also a definitive Thai identity. Thais all stand and take off hats for the Thai national anthem before movies in the theater, before sports events, etc. We respected this every day on the fields at the ultimate tournament, and we greatly admired the agility of a composer who had written a national anthem for the three notes of a bugle. It is a criminal offense to disparage the Thai king, the Kingdom, or any representative part of it, and visitors to Thailand respect this.

Iraq and Burma seem to be victims of the same syndrome as Italy, being lands of many cultural centers and advanced learning. France has one dominant center – Paris, and England has London. Over recent centuries, both France and England have been great world leaders. Long ago, when Rome was the most advanced of all, they was the Roman Empire. More recently, with strong national identities in Rome, Milan, Naples among them, many cooks stirring the same pot has led them to burning the bottom of their savory stew since they can't decide whether the spoons should all go clockwise or the other way. I'm a hack historian, but it's my impression that in Iraq, also once a great center of learning and advanced culture, there has been great dissent in the last century due to too many strong centers, and disparate identities, none willing to be subordinate to another.

While the hill tribes in Burma didn't exactly invent the pendulum, the have strong identities, and tribal histories of being great warriors that kept the enemy at bay for thousands of years. According to Pascal Khoo Thwe's memoir, "From the Land of Green Ghosts", at certain times such as shortly after the birth of a new baby, strangers who accidentally wandered into their village he would be killed for fear he might be an evil spirit, or bring them. When the author began at the state school, his grandfather – more wisely than you could imagine – advised him to say at school that the world was round, while back in the village that it was flat.

Some of my sources tell me that all of the 17 major dissident groups have truces with the SPDC, except the KNU. The DKBA has truced with SPDC, and cooperates with them in some capacity, it appears. While they are both Karens, the DKBA do not join together forces with the KNU because the former are Buddhist and the latter are Christians. Ah, religion, the great divider amongst men.
Thursday, March 11, 2004
 
My visa expires in a few days, so sometime this week I will have to go to Nepal, or down the 3km to the Burma border to renew it. One must pay their $10, cross over and come back, to get another 30 days. I paid $25 back in NY for a two-month visa – that's how long I've been here already. Frankly, it feels like longer.

The day after getting back from the Bangkok ultimate tournament, I ran into two New York ultimate players in Mae Sot. They were traveling around Asia, Australia & New Zealand. Crossing paths with them was especially serendipitous, as Carrie and Patch are hard-core players on their way back to the big beach ultimate summit in Rimini, Italy over Easter, but had not been to the tournament in Bangkok. Carrie and I played together in Rimini the last two years, and Patch had been with us two years ago, missing it last year being off in Alaska studying windmills and solar panels. I had heard some gossip about Carrie and Patch, but I guess we're beyond that stage now.

Since running into them I've had some frustrating dreams about trying to get onto a team going to Rimini. It's really sad for me to miss that tournament, as many of my favorite people in the world will be going. The only time I've missed Rimini since 1997 was in 2000, when sadly I was stuck at the Bali tournament, getting $3 hour-long massages on the beach, eating marlin sushi, papaya shakes every day. It's hard to be stuck in Asia and miss Rimini. I am behaving and not pricing tickets to Milan.

Even if I'm not giving a hard sell to anyone to come visit me in Mae Sot, it really was nice to see some people I knew and to show them around my world a little. Pathetically, a couple of meals with them and a walk around town was my third big social event of the season, after the tournament, and the big night out in Mae Sot with the NGO types to watch that film slamming NGOs.

The came to see me at the clinic the next day where they got to meet Dan and Sophia and the OPD medics. I showed them around the clinics, Carrie braved the latrines, and we went back into town for lunch. They had been down to the border in the morning, paid their $10 and crossed over. Carrie said they were feeling remorseful for giving money to the SPDC – they hadn't been sure what the process was as far as who would be getting the money, but were pretty sure it was the Burmese, and were feeling badly about it. They also said they were swarmed by people selling things and wanting to take them on a tour. They said it wasn't very pleasant and they didn't stay long.

Some American gals I met in Spain said that when they got to Morocco they had been swarmed by large Moroccan men offering to be their "guide", and refusing them all, had been harassed all the way to their hotel rooms. They eventually realized that if they had taken one on, he would have shooed away the rest of the swarm of them, and they would have had an easier time getting to their destination. Keeping this lesson in mind, when I go over the border in a day or two, I may consider taking on a guide. This may leave me somewhat in peace, and in some cases a guide can negotiate better prices on goods on one's behalf. If these would be individuals and not government employees, it would be helping the people's economy as well. It would be nice if I could do some sight-seeing with an English-speaking guide on bicycles, as I'm still a little scooter-shy, tuk-tuks (like a rickshaw but motorized) are loud and polluting. The bicycle-style rickshaw-tuk-tuks I could probably handle, though I'd feel uncomfortably like a colonialist.

When I was in Bali four years ago, Dan had offered up his place in Jakarta to stay to me and Maya, an ultimate player I traveled with after the tournament. He'd given us the address and the name of the "house boy" who would let us in. I had cringed at the term for the domestic help, and had been relieved upon arrival a month later to find that the "house boy" was about 16 years old. It was truly bizarre to be in a place where I would put a fork in the sink, go off to use the loo, and come back to find the fork already washed and in the drying rack. I knew how to do my own dishes, I could clean my own clothes. It just feels weird to have someone else doing domestic work for me.

I said as much over dinner one night to some of the Jakarta ultimate players, that if you have the monetary means, why not just give your money to the poor people, why humiliate them by making them do your domestic chores for you. The had an emphatic answer that consisted of the value of employment and hard work, how much better it was to employ locals than to turn them into charity cases.

I've had the same thoughts here on the two occasions when I've gone for Thai massage. In a poor economy with little opportunity, who can tell whether a vocation is one of choice or of necessity. The first massage had been at the Wat Pho in Bangkok, given by a guy in his 60s with black shoe polish in his hair who could say, "Lie down, sit up, turn over," in English. He could have a second career as dog trainer if he liked. Thai massage is given with the client wearing loose, cotton fisherman's pants and shirt, something like hospital scrubs. The massage therapist uses hands, elbows and knees to dig into muscles. They way they move you around and flip you over into different positions, tangle you up to stretch you out, when it's over you will be a relaxed customer or a perfectly tossed NY pizza crust.

This guy had been a perfect professional, skilled in his work and clearly enjoying it. He talked the whole time to me and to his young female assistant, who had been the one to point out the shoe polish in his hair to me, and tell me how old, very, very old he was, jibingly, as they had worked together for several years, they told me. She said he'd been a massage therapist for over 30 years. In the end I did feel like a very relaxed piece of bread dough, and the assistant had sent me off with a French braid in my hair.

I wasn't so enthusiastic about the Thai massage I had here in Mae Sot. Perhaps because it was because the woman giving it to me seemed less enthusiastic, although she was perfectly nice and went through all the motions. She didn't respond to any of the Thai or Burmese I tried on her, so it wasn't a social event. You can't fall asleep during a Thai massage as your limbs are constantly being bent in and across one another, with the therapist's feet in your armpits and her elbows digging deeply, roughly, into your knotted IT bands.

When you get a massage in the States, you know the therapist has chosen this profession and is probably really into the healing nature of it. Perhaps it was just this gal, but the one in Mae Sot seemed to be coming in to do a job and get paid for it. It still seems like it would be a better job than domestic work in a Thai home or restaurant, especially if your language skills aren't good. It certainly is a better option than prostitution, which is a tangible possibility for many women in this region. I wouldn't demand that someone I hired to do domestic work or give me a massage give me a big, obsequious display of how much she absolutely loved washing my running shorts. As I had said, I have seen at the clinic how much good doing work does for a person. My own, new, alien position in this country as a person of means who hires others to do my laundry, rub my feet, give me a tour around Burma, was one I would have to examine and reconcile on my own.
Wednesday, March 10, 2004
 
Brief cultural notes:

In Burmese culture it considered rude to blow one's nose, but picking one's nose is perfectly acceptable. I have had many conversations during which one of the other parties will sit placidly with a finger up the nose for several seconds on end. Not digging around, just sitting there with a finger up the nose.

In the West, we mostly keep our shoes on until we are home and not planning further excursions outside for the rest of the night, unless we are visiting Jenny's Inwood apartment where we are firmly reminded to remove them halfway up the lobby stairs lest we forget. When we remove them at Jenny's house, we neatly line then up in the foyer, and pick them up in the same civilized condition on our way out. In Thailand, shoes are removed outside of all inhabited places and some shops, although they are kept on in restaurants. The shops in Mae Sot where one removes one's shoes may in fact be Burmese run. Nevertheless, one's shoes will join a neat row of other shoes outside the shop.

In the clinic, at which Burmese culture is de facto observed, shoes are kept on in the OPD (out-patient dept.), but removed outside of administrative offices, classrooms, and the IPD. I have watched in amazement as someone will walk right through and UPON a splayed arrangement of shoes that reminds me of traffic at 6pm outside the Holland tunnel. As no walkway is left between rows of shoes, and there will sometimes be more than a dozen pairs outside a doorway, some people will just walk right over the shoes that were there before and doff their own just at the entrance. I will often find my own black Reefers, usually left at the periphery of the pedal herd in waiting, covered in dust in distinct patterns of shoe soles.

In the States we drive on the right side of the road, and generally speaking, walk on the right side of the sidewalk or the hallway, although of course there is no law or rule about this latter point. It is just convention, to diminish chaos. In Australia, they drive on the left side of the road, and generally speaking, keep to the left when they walk. In Thailand, they drive on the left side of the road, and yet they keep to the right when they walk. There seems to be more confusion on this point amongst Westerners than amongst the Thais.

The practice of keeping to the left while on the road is may be a matter of convenience for Buddhist Thais, as it causes one to take the clockwise route around the roundabouts. This is known as a kora, a clockwise circling of a cairn, a room, a building, even a city. It is done in Buddhist meditation, but is extended in everyday life at times, I have been told. This may be solely a Nepalese practice, as it was of Nepalese Buddhists the practice was described. In the Himalayan foothills, I'm told, if there is a large rock in the middle of a walking path slightly off to the right as one ascends the mountain, there will naturally be a well-trodden path to its left. However if one looks closely, once can see a path less-trodden around the other side, as people observe the clockwise kora as they descend the path.

It is easy to fall into the trap of a question of which culture is superior. We say, picking one's nose is unhygenic and leads to colds and other viruses. But in a culture where there is no tissue paper, and no pockets in sarongs for handkerchiefs, the alternative is to blow one's nose on one's clothing or on the sidewalk, or on the floor where people walk barefoot.

I don't know what to say about driving on the left but walking on the right. And I'm sure someone has worked out mathematically why driving to the right is superior, now that the days are over when jousters and musketeers steered with their left hands while fending off oncoming enemies with sharp objects in the right.

The shoe thing is more complicated to me. In the culture where I come from, it would be unthinkably bad manners to walk with dirty, dusty shoes all over other people's shoes. Or even with clean shoes. Granted that at home, we'd be talking about black-soled Dingos, $400 Italian imports, spiky numbers by Prada, and muddy cleats and running shoes. The stakes are higher than they are with $0.40 rubber thongs (or in my case, $40 rubber flipflops). Perhaps it's a lack of respect for a cheap, mass-made objects that doesn't deserve respect. Maybe at home it's a retentive obsession with material objects that makes us throw a fit every time we find a new scratch on our cars, which are meant to get us from place A to B, but represent oh-so much more. Still, if cleanliness is what dictates here that we take off our shoes outside, what gives with not observing the clean top side of the shoe and the dirty bottoms?

I learned a semi-related lesson last week. Since moving into my new guest house, where I have my very own private bathroom, I no longer need at home the rubber bath sandals that I used on the trek up and down the stairs from the Rapunzel room to the loos, and wore in the common shower. So I brought them to the IPD, where one doffs one's shoes at the threshhold in exchange for the indoor shoes. Dan seems to keep his separate, with red thongs for outside and blue ones for inside, and he never seems to lose them or get them mixed up with someone else's. This could have to do with the fact that he's the only one in town with men's size 11 feet. I, on the other hand, lost my women's size 8.5 sandals within the hour of bringing them to the IPD, despite being many sizes too large for any of these size 4 gals. The lesson here is, if you want to keep your $0.40 shoes, you have to bring enough to share with the whole class. Next time I make it to the market I will pick up an array of sized of rubber sandals, enough for the whole class.
 
The business with the menstrual calendar reminded me of an incident back in midwifery school. A preceptor, a couple of years out of school, had come in with me to see a patient carrying twins. The patient wanted to clarify how far along she was, how long she had to go, and when she was due. As it was June, and she was due in October, the preceptor told her she was five months along, and had five months to go. I was puzzled – perhaps the preceptor meant she was IN her fifth month, so she was in fact four months along. The patient was puzzled, five months, so she was due in November?

The preceptor became very animated as we tried to clear this up. "Look. How many months is a pregnancy?"
"Nine," I replied.
"No, it's ten. Forty weeks in a pregnancy, four weeks in a month, ten weeks in a pregnancy."
"But…," I hesitated, as her logic was so, er, not what I was expecting, "but only February actually has only four weeks. And a pregnancy is nine full calendar months."
"Ah, nine FULL calendar months," she said with sharp eye-contact, "but ten lunar months. And besides, it's just easier for them to see it on a calendar, counting down four weeks until the next visit. We'll talk about this later. Honey, you're five months along."

Later on I got reamed out for correcting a preceptor in front of a patient. It was one of those cases of a little bit of power corrupting just a little bit, but being enough to secures one's grounding as an anarchist. I am not pro-chaos, chaos being a lack of order all around. As an anarchist I am opposed to hierarchies, as they almost always lead to some group being treated disrespectfully by another. This was a case where the authority figure was being clearly weird and confusing the patient, who genuinely wanted to know how far along she was. I tried to point out to the preceptor – later, in private – that most people are on a normal calendar, not a lunar one, not a Gregorian one (although, I now know that we are in fact on a Gregorian one), and that elevating a patient's knowledge and understanding of her pregnancy should be priority. She replied that she was equally concerned that the patient trust her in her knowledge so that she not be stressed out about her pregnancy, and in that aim I don't disagree with her. But if you're going to be rigid in your authority, you have to have your information straight.

If there is any hierarchy I support, it is that of a teacher and a learner. But even then it is important to the process that both parties be treated with respect. When a student has to kiss up to a teacher, or say, "Yes, sir, I'll turn my nine page paper into a nineteen pager if that's what it takes to get an A, and by the way I’m really enjoying Ulysses even though I don't understand a word of it," then some of the meaning of education is lost.

People function better when their confidence is up and they feel capable and appreciated. I see this with the medics at the clinic, who essentially function without any supervisor or "superior", and pretty much without pay, though the life they have at the clinic is better than in a refugee camp or back in Burma. They do their work at the clinic because it is what they do, and they believe in the importance of it. From what I can gather from body language and visual cues around me, this is a sort-of post-feminist utopia where everyone treats everyone with respect, regardless of sex or social status.

My position here of trying to improve the system and the technique of the medics is an odd one. I don't really have any direct role models for the role I am playing. When I was in school and later my residency, then in a job, if someone told me what to do, I had to do it or face getting a bad grade, or getting fired. Authority figures like being questioned only so much. I once had to make a formal apology with a speech in flowery language to someone who had shown me a yeast bud under the microscope, and mistaking a magnified piece of lint for what she was pointing out, I had blurted out, "What, that thing, really?!" She had been indignant enough at my apparent doubt of her that she had complained to my residency preceptors. I had had to get down on my knees and beg her not to punish future midwifery students who visited her department for my insolence.

Perhaps it was these experiences that led me to be insensitive to Cheri's need not to lose face when I disapproved of her episiotomy when I first got here. She could choose to ignore me entirely for the half year I'm here, and nothing would come of it. She wouldn't get fired, reamed out, or a bad grade. Some medics are more eager than others to learn from me, and some do their own thing and stay out of my way. I have to tread tenderly to change a technique because they are in no way obligated to listen to me.

It is a real pleasure, though, in fact, working with students who don't expect to get reamed out, and who don't fear my authority. They never question what I say in a challenging way, perhaps demonstrating more sensitive social skills than I displayed in school. But they are starting to be more interested in what I have to teach, the more confidence I gain in being able to pass along to them what is on my mind. And perhaps, the more the realize I won't say, "Ack! What are you doing? Stop!"

During my daydream about Nepal, and whether the world would be better served with me there or here, I was struck by the Cupid of academe. I have been overwhelmed by the cold, medical environment of the delivery room, and at a loss as to what to do about it short of suggesting they put mattresses on the floor instead of using the scary aluminum tables. But then it occurred to me that I have overcome the scariness of doing births in this environment in the past.

The medics don't really talk to the women while they are in labor or giving birth. And though I can't understand their conversations in Burmese, I would doubt that the medics in the antenatal clinic give much counseling in mental preparation for birth, either. This is an easy guess because no obstetrical text book teaches overcoming the fear factor in pregnancy and labor. And because using all of my fingers and toes, I can't count how many times after I explaining the birth process to a pregnant woman I've been told, "Wow, thank you for telling me all of that, you're the first person who has made me feel not afraid to give birth," I am sure that this is an area of preparation for birth that is most often neglected, by birth attendants around the globe.

When I have the time in the antenatal clinic at home, I will spend a half hour with a pregnant woman, describing the magical way the body gives birth, discussing a birth plan, figuring out what her fears are, and giving her a pep talk that includes advice to tell anyone with horror stories to stuff them. I have a whole monologue I tell to anyone who will listen – pregnant friends, not-pregnant friends, people sitting next to me on the bus. To people who don't understand it, giving birth is the scariest thing in the world. It's incomprehensible that this BABY could come out of your body. I give them a demonstration with a crumpled piece of paper to represent the fat, fleshy cervix dilating and becoming paper-thin, like a Chinese paper lantern opening up. Visual demonstrations are helpful.

I also point out that normally when you feel pain, any other time in life pain represents injury your body: a broken wrist, a sprained ankle. Pain means damage, which causes fear at the idea of a damaged body. Pain in childbirth is the only time pain doesn't mean damage, so she needs to adjust her associations with this new and difficult sensation so that fear and pain don't reinforce one another. After all, there are no epidurals and no demerol here.

I discussed some of these ideas with the medics, to see if I could articulate them to a non-patient. I started to tell Sin-La, since she is the one who lately has been bringing me in to see patients with her, and back to their loft for lunch. She listened attentively, then said that she would start talking to the patients about this. A couple of other medics came over to hear what I was telling her, so I began again from the beginning and gave them a basic run-down.

With this bee in my bonnet, I ran over to find Dan to tell him I'd like to give a class on the subject. I still feel like I'm getting his approval for things like this, but he's very laid back and always gives it, and who doesn't like positive reinforcement? He hasn't objected yet to being my sounding board. He didn't have a class planned for the next day, so I ran home and wrote up lecture notes in preparation to teach. Suddenly I didn't feel such a great need to run off to Nepal to get my ya-ya's out.

At 3pm the next day at scheduled class time when the IPD shifts changed, medics trickled in with their notepads, but I was soon informed that neither Tender nor Sophia was there to translate as they were both off at a conference. I had been stressed out all morning about giving this talk, as it is soft science, I had never been given a talk on this topic myself in school so this was completely my own material, and I think it is one of the most important aspects of whether a woman has a good birth experience or not, and indeed can effect whether she has a successful one naturally or ends up with a c-section. After all, what is the difference between good sex and rape, if not fear and the lack of control? It is vital to minimize these harmful factors in labor.

So when class was canceled I was disappointed, but the headache and racing heart I'd had all morning abated. I sat and chatted with one of the medics and gave him a rundown of what the talk would eventually be on. Since there would be no pop quiz, I told him I would be asking them to help me list things that might cause fear in pregnancy and labor. I myself listed, among other things, pain, death, attack by the SPDC.

I asked him how to say "breathe" in Karen, and he told me, "Gatha law, gatha taw," breathe in, breathe out. I told him that was very useful to know, as I sometimes did that myself when I was anxious. Indeed, I had been taking deep breaths over lunch to try to relax. I have no idea why I was so anxious about giving this talk, as my last one had gone well and had been a lot of fun, and this was a topic I knew a lot about, as I kept reminding myself.

He asked me when do I get anxious, in a way that made me think that perhaps he couldn't envision me being anxious, which I find hilarious. I smiled and cocked my head back and forth, stalling while I tried to decide whether to make something up about this ultimate tournament I'd just been to or something, when he said, "I get nervous before taking a test, but I don't get nervous before battle."

"Before battle? Did you say before battle?" I asked blankly. I wanted to make sure I had heard him right. He grinned broadly and nodded. "When do you do battle, with the SPDC?" It's still hard for me to grasp that this is someone's real life, not play in the backyard, not video games.

He told me that back in his village, the Karen would fight with the SPDC perhaps four times in a month. The SPDC have a permanent presence in town, and there were frequent altercations between them and the villagers that would erupt into gunfights.

I felt thick asking, "And, people get shot? And, people… die?" Yes, yes, he confirmed. He grinned the whole time, surely as a way to avoid any melodrama.

He said that sometimes the SPDC just would disperse a village, and anybody remaining would be shot. I asked him why, but there seemed to be no answer. I asked him what the SPDC wanted, did they want the Karen land, why they are so hostile to the Karen? He said that the Karen fight them, do not cooperate with their politics. The SPDC take the people for forced labor, and naturally this causes some tension.

In a case where two young men defected from their "volunteer" slave labor, the military dispersed their village in retaliation. The medic told me that the young men in a village would be taken away and used as porters for the military, and fed but given no pay. During planting season they would alternate on a weekly basis, being gone as military porters, come back and work for a week on the farm, then have to go away again.

There are missions in life, then there are missions in life. Engaging in gun battle with an oppressive military regime would seem a lot more anxiety-provoking than whether or not I would deliver a well-structured lecture.
Tuesday, March 09, 2004
 
My visa expires in a few days, so sometime this week I will have to go to Nepal, or down the 3km to the Burma border to renew it. One must pay their $10, cross over and come back, to get another 30 days. I paid $25 back in NY for a two-month visa – that's how long I've been here already. Frankly, it feels like longer.

The day after getting back from the Bangkok ultimate tournament, I ran into two New York ultimate players in Mae Sot. They were traveling around Asia, Australia & New Zealand. Crossing paths with them was especially serendipitous, as Carrie and Patch are hard-core players on their way back to the big beach ultimate summit in Rimini, Italy over Easter, but had not been to the tournament in Bangkok. Carrie and I played together in Rimini the last two years, and Patch had been with us two years ago, missing it last year being off in Alaska studying windmills and solar panels. I had heard some gossip about Carrie and Patch, but I guess we're beyond that stage now.

Since running into them I've had some frustrating dreams about trying to get onto a team going to Rimini. It's really sad for me to miss that tournament, as many of my favorite people in the world will be going. The only time I've missed Rimini since 1997 was in 2000, when sadly I was stuck at the Bali tournament, getting $3 hour-long massages on the beach, eating marlin sushi, papaya shakes every day. It's hard to be stuck in Asia and miss Rimini. I am behaving and not pricing tickets to Milan.

Even if I'm not giving a hard sell to anyone to come visit me in Mae Sot, it really was nice to see some people I knew and to show them around my world a little. Pathetically, a couple of meals with them and a walk around town was my third big social event of the season, after the tournament, and the big night out in Mae Sot with the NGO types to watch that film slamming NGOs.

The came to see me at the clinic the next day where they got to meet Dan and Sophia and the OPD medics. I showed them around the clinics, Carrie braved the latrines, and we went back into town for lunch. They had been down to the border in the morning, paid their $10 and crossed over. Carrie said they were feeling remorseful for giving money to the SPDC – they hadn't been sure what the process was as far as who would be getting the money, but were pretty sure it was the Burmese, and were feeling badly about it. They also said they were swarmed by people selling things and wanting to take them on a tour. They said it wasn't very pleasant and they didn't stay long.

Some American gals I met in Spain said that when they got to Morocco they had been swarmed by large Moroccan men offering to be their "guide", and refusing them all, had been harassed all the way to their hotel rooms. They eventually realized that if they had taken one on, he would have shooed away the rest of the swarm of them, and they would have had an easier time getting to their destination. Keeping this lesson in mind, when I go over the border in a day or two, I may consider taking on a guide. This may leave me somewhat in peace, and in some cases a guide can negotiate better prices on goods on one's behalf. If these would be individuals and not government employees, it would be helping the people's economy as well. It would be nice if I could do some sight-seeing with an English-speaking guide on bicycles, as I'm still a little scooter-shy, tuk-tuks (like a rickshaw but motorized) are loud and polluting. The bicycle-style rickshaw-tuk-tuks I could probably handle, though I'd feel uncomfortably like a colonialist.

When I was in Bali four years ago, Dan had offered up his place in Jakarta to stay to me and Maya, an ultimate player I traveled with after the tournament. He'd given us the address and the name of the "house boy" who would let us in. I had cringed at the term for the domestic help, and had been relieved upon arrival a month later to find that the "house boy" was about 16 years old. It was truly bizarre to be in a place where I would put a fork in the sink, go off to use the loo, and come back to find the fork already washed and in the drying rack. I knew how to do my own dishes, I could clean my own clothes. It just feels weird to have someone else doing domestic work for me.

I said as much over dinner one night to some of the Jakarta ultimate players, that if you have the monetary means, why not just give your money to the poor people, why humiliate them by making them do your domestic chores for you. The had an emphatic answer that consisted of the value of employment and hard work, how much better it was to employ locals than to turn them into charity cases.

I've had the same thoughts here on the two occasions when I've gone for Thai massage. In a poor economy with little opportunity, who can tell whether a vocation is one of choice or of necessity. The first massage had been at the Wat Pho in Bangkok, given by a guy in his 60s with black shoe polish in his hair who could say, "Lie down, sit up, turn over," in English. He could have a second career as dog trainer if he liked. Thai massage is given with the client wearing loose, cotton fisherman's pants and shirt, something like hospital scrubs. The massage therapist uses hands, elbows and knees to dig into muscles. They way they move you around and flip you over into different positions, tangle you up to stretch you out, when it's over you will be a relaxed customer or a perfectly tossed NY pizza crust.

This guy had been a perfect professional, skilled in his work and clearly enjoying it. He talked the whole time to me and to his young female assistant, who had been the one to point out the shoe polish in his hair to me, and tell me how old, very, very old he was, jibingly, as they had worked together for several years, they told me. She said he'd been a massage therapist for over 30 years. In the end I did feel like a very relaxed piece of bread dough, and the assistant had sent me off with a French braid in my hair.

I wasn't so enthusiastic about the Thai massage I had here in Mae Sot. Perhaps because it was because the woman giving it to me seemed less enthusiastic, although she was perfectly nice and went through all the motions. She didn't respond to any of the Thai or Burmese I tried on her, so it wasn't a social event. You can't fall asleep during a Thai massage as your limbs are constantly being bent in and across one another, with the therapist's feet in your armpits and her elbows digging deeply, roughly, into your knotted IT bands.

When you get a massage in the States, you know the therapist has chosen this profession and is probably really into the healing nature of it. Perhaps it was just this gal, but the one in Mae Sot seemed to be coming in to do a job and get paid for it. It still seems like it would be a better job than domestic work in a Thai home or restaurant, especially if your language skills aren't good. It certainly is a better option than prostitution, which is a tangible possibility for many women in this region. I wouldn't demand that someone I hired to do domestic work or give me a massage give me a big, obsequious display of how much she absolutely loved washing my running shorts. As I had said, I have seen at the clinic how much good doing work does for a person. My own, new, alien position in this country as a person of means who hires others to do my laundry, rub my feet, give me a tour around Burma, was one I would have to examine and reconcile on my own.

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