Chasing Green Ghosts - Midwife in Thailand and Burma
Saturday, January 31, 2004
Yesterday I tried to watch as a medic (guy) attended a birth. But as he was at first modestly standing up next to the mother's head and nowhere near the important parts, and later standing back watching until the moment when he intended to do the predetermined episiotomy – I just couldn't help myself and jumped in to show him proper hand techniques – pushing down on the fetal head so it doesn't scrape the urethra, while supporting the perineum to prevent a tear. They would need to learn to listen to the fetal hearts more often, as it seems to be done here less than hourly in labor. Since the fetal heart was good there was no need to rush getting the baby out, though I could see them getting impatient as it was 3pm and the shifts were changing. It would have been a brilliant demonstration of patience producing a baby through an intact vagina, but there was a compound presentation of a hand next to the face with a protruding elbow that nudged a tear in the perineum. It was superficial and not into the muscle layer, easily repaired.
I'm not sure demonstration is a better teaching technique than watching, commenting, prodding in a better direction. I've been trying to keep my mouth shut and observe and let them get used to my presence before getting involved, but it's hard when you see them doing dangerous things like injecting local anesthetic without assuring they're not in a blood vessel. Besides, what fun is it just to watch?
Last week (while I wasn't there), a woman whose exam showed her to be 4cm. dilated with membranes intact, then went 12 hours without another exam. When they did check her again, they found a prolapsed cord – an umbilical cord that had come down ahead of the fetal head. Immediately after a healthy birth, you can feel the pulse of the cord as it still brings oxygenated blood from the placenta to the newborn. If there had been a pulse in this prolapsed cord, they'd have rushed her to the Thai hospital for a c-section. But there was no pulse. When the medics explained to the mother that her baby had died, the mother was like, "Yah, ok."
In the wake of this, I reorganized the chalkboard on which all the laboring women are listed. In addition to the their names, date of admission, time and status of last exam, I added number of prior births (gravida & parity), due date, fundal height, more details about the exam such as fetal heart rate (to make sure they check it), and plan for time of next exam. There have been some confusions where they write "H" for head down, and I write "vtx" for vertex, and they use a different standard for how low the head is, but the differences are minor and I think it's slightly more organized now.
I have also been adding estimated fetal weights, but I'm the only one who knows how to do them, or what to do with them. At home I regularly guessed more accurately than the residents and their ultrasound machines, the fetal weight compared with the actual weight of the newborn, just by feeling the fetal profile through the mama's abdomen. It's something I'm teaching the medics to do here. It doesn't help that I haven't done it in a couple of months, and that I've been off by a couple hundred grams on the ones here – which is a pretty good margin of error which is why it's called an estimate, but the medics don't seem convinced. In any case, you should always have enough people around in case it's a big baby, and resuscitation equipment in case it's a small one.
There's a textbook in the clinic written in the 1970s in Britain, which I've been using for reference. It's about on par with the technology we've got, so I've been getting some good clues of other symptoms of pregnancy that arise at different times, which could help with being more accurate about figuring out due dates. In NY, people are pretty good about knowing their LMP (last menstrual period), but we also have ultrasound for sizing a fetus. One midwife said women report accurate LMPs, but the evidence is to the contrary, especially when gestational age is listed on sequential visits as 28, 34, 38, 35wks. Another one is measuring fundal height (size of the mother's abdomen): after 20 wks, the distance measured in centimeters between her pubic bone and the fundus (top) of her uterus should match the gestation of her pregnancy in weeks. As my dad says, God works in metric, too. The convention they use here is fundal height plus 3 equals weeks gestation. My assumption was that Burmese women are small, but then my own measurements are about two centimeters greater than those of the medics.
It's important because if a baby is born too early, it may have breathing difficulties. If a woman passes an accurate due date (@40wks) by weeks, the placenta may give out and the fetus will lack sufficient oxygen. The hands-off midwifery approach is to let the mother and fetus do the natural work together they were designed to do. But then, some women do have their water break early, and it's good to know if you want her to give birth or to stay pregnant a little longer.
I would like the midwives to note whether they can hear the fetal heart with the doppler (12+ weeks) and with the stethoscope (20+wks). And to ask the women how long they've been having: morning sickness (4-14wks), breast changes (4+wks), nipple changes (landmarks at 6, 12 & 20wks), clear breast fluid (12wks) and colostrum (20+wks), increased need to pee (4-12wks), changes in appetite (from conception), and perhaps most importantly (but not necessarily most reliable) if and for how long she's been feeling the baby move (16+wks). Incredibly, there's nowhere on the forms to note whether she's been feeling the baby move today. I had a case in Brooklyn where I myself reminded a women at three prenatal visits, as part of my usual prenatal lecture, to come back to see us that very day if she felt the baby move any less than usual; but her fetus died after two days of decreased fetal movement without her coming back. Still, they must be reminded every time that that is their best indicator the baby is doing well. Another neat trick that doesn't always work, called ballotment, is giving a good poke to the fetus through the mother's lower abdomen; a fetus from 16-30wks. will rise up in mother's abdomen, then settle back down. Pretty much after 20 wks. you're going on fundal height, and it's too bad if she doesn't come to the clinic until after this point because natural variation in grown rate, as well as effects of varying nutritional state, can skew the due date if you rely on size. Nutritional status is one of the big factors in determining the outcomes of mother and baby after birth, if you're from Burma or Brooklyn. At prenatal visits the women get advice; testing for HIV, Hep.B and malaria; vaccination for tetanus; iron tablets, folic acid, and in some cases eggs and fish to bring home.
Thailand would seem a difficult place to survive for a strict vegetarian. Fortunately for me I'm of the lazy, semi-practicing type who never goes to congregation. I've figured out how to say, I don't want any meat ('animal food') at all, which often gets me a chuckle and a dish with rice, veggies and shrimp. Shrimp is apparently a vegetable in Thailand. Similar to when I moved to Spain as a vegetarian in 1996 I was told that the national vegetable of Spain was ham. People here actually eat and know how to cook veggies and I get 'em at every meal.
The weight of my large backpack and small day pack and my sore muscles the day after carrying them up here would suggest that I didn't travel light, but I seem to have a dearth of appropriate clothes nonetheless. I normally wear tank tops at home in the summer and carry a long sleeve shirts in the case of excessive AC as is the case at most indoor locales, including the workplace. I just don't like t-shirts, but that's what the gals wear over their awesome hand-woven sarongs. Fortunately my pack arrangement was just large enough to fit everything I absolutely couldn't do without, including nine books on either Burma (Burma Behind the Mask, From the Land of Green Ghosts), health issues (Where There Is No Doctor, Love in the Time of Cholera), or kooks in Florida Everglades. My backpack, which is worn just enough not to look like a target, was a gift from a Canadian friend of mine just before I left. My only disappointment about it is that it didn't come with Canadian travel insurance: a Canadian flag patch sewn onto a prominent place.
The one item I impulsively put in my pack, which I've never brought traveling before, which I am most thankful to my guardian angel for giving me the impulse to throw it in, is my whistle. It's a small wooden thing, two inches long and flat, with a dragonfly painted on top. This little number has saved me numerous times just in the past week from the mad dogs that populate the corners of Mae Sot after dark. I mean mad ambiguously cause I don't know if they're angry or cuckoo. I was bitten once in Brooklyn by a dog that looked the other way until I biked past then lunged at my ankle. That's what dogs do when they really want to get you, they ignore you 'til you're close enough, then they strike.
Fortunately this has not happened to me here (yet). A dog chased me into the waves when I went running at dawn on my weekend on Ko Samet island, and since then I've worn my whistle on a string around my neck whenever I've gone out. I give a couple of toots of warning, which startles them, and blow harder making a higher pitch if they keep coming, to let them know it'll get worse if they don't back off.
They don't bother me as much on the bike as on foot, although a few nights ago one startled me and I screamed so loud I startled myself, and also the dog who I swear had a shocked look on its face as it jumped back. The females with teats as long as a cow's that drag on the ground look hungriest, but are never aggressive.
Dan and Jane lent me someone else's bike 'til she gets back in a few weeks. This has turned my 20 minute walk to work into a 7 minute ride, so I'm doing more exploring of the area most days after work. The plan has been to bike to a less populated, less trafficked part of town (maybe up north where I biked last weekend) and do some running. It hasn't happened this week because it's just too freakin' hot and polluted in the air in the afternoons, and I've been getting up too late since the pots and pans have been keeping me up past my preferred bedtime.
The people at No.4 Guest House told me they have no monthly rate since they often have large groups staying there on their way in or out from a trek. I've moved to another guest house which is a bit more expensive for a slightly larger room up on top of the back wing of the house. I get a nice breeze, it's well-screened up and I haven't seen a mosquito in the room yet. There are windows on three sides which is great for light and air, but bad for noise. It's feels like the kind of tenement house in Brooklyn my Nana tells me about growing up in. If Rapunzel were from Williamsburg in the 1930s, this is where she'd live. I hear babies crying at all hours, the banging of the pots down in the restaurant kitchen often until 11pm. There was a parade of ants that went in and out and in and out of four holes in the wall like a highway through mountain tunnels, until I plugged up the holes with squirts of sunscreen.
If I lose enough sleep I might decide to move down to the more isolated but expensive guest house, at $130/month, vs. this $70/month. But then I'd be way out of proximity to the conspiracy theorists. Besides, I've spent a cumulative hour arranging my new mosquito net over this bed. Since it didn't come with any cords or hooks, I've rigged it up from the window curtains using a purple hankie, a belt and my travel hammock/clothesline that balls up into the size of a fist. It looks like I collaborated with McGyver but it keeps the non-existent mozzies off me so I can sleep more restfully until the rooster that is cuckoo begins to crow at 4am (two hrs before sunrise, I note).
Friday, January 30, 2004
I've only lost a little sleep over the encounter with the immigration officer. I think I will at least avoid that restaurant for a while, though it's a small town and there are only three or so places foreigners stay, and some folks have been here for several years now and are well-recognized around town. No one has given me a serious talking to about completely not discussing the clinic, though discretion seems to be the best policy. It's just not in my nature not to be totally psyched to be a midwife and want to tell everyone. Guess I can learn to keep my good news to myself for a while.
Today I did ask Jane, Dan's wife, whether she knew of any foreigners in connection with the clinic or any other orgs. having been arrested. She said she hadn't and that relations were pretty good right now between the relief orgs. and the Thai authorities. Last year there was a Japanese national who was around for a while, claiming to be a tourist, but was rumored to be involved with arms smuggling to the Karen rebels. He was found hanging next to the Asia Highway on the north side of town. Similar story with a Frenchman who was disappeared, rumors abounding regarding his fate. Jane said there is a group of "farangs" – foreigners – mostly married to Burmese women, that meets at a certain pub on a certain night and can discuss conspiracy theories for hours. I'm still learning about it, but I'm not sure what conspiracies she could mean: oppressive oligarchical regime commits oppression and ethnic cleansing of minority tribes, where's the conspiracy? Just to CYA I'll save the unpleasant details for people who write me email, since to stay safe, Jane said it's best to keep your nose clean and not discuss politics. Jane says…
Not so sure about the Burmese food at the clinic. Very much more foreign than the Thai food in town. Not bad, and I've only a little listless lately. Thai food in town is delish. Yesterday my half of the conversation with the guy at the restaurant, in Thai, consisted of, "Do you have Pad Thai? Do you have Pad See You? I don't want any meat at all. Oh, tofu, yes yes. Ok. I'd like chilies, please ... thank you, it was delicious. how much? thank you." A guy sitting with the owner started speaking to me incomprehensibly in Thai, then switched to English asking, "How long have you been here (1 week), how long will you be here (a few months), your Thai is perfect, one week, incredible! Where are you from (NY), where in NY (Brooklyn), oh me too, Kings Highway! What are you doing here (working at the clinic). Oh, I work at immigration."
OOPS!
Fortunately I didn't have a panic attack at just having turned myself in to the border police, as I've heard that there are plenty of ex-pats doing "illegal" work with Burmese immigrants who are well-known by the local police, and been befriended by them. I told him I would look for him when I came to renew my visa. Not in jail yet.
Thursday, January 29, 2004
Realization of communication hurdles hit a new peak tonight as the third internet cafe I tried in Mae Sot denied me the ability to reply to my emails. I can read them, and fortunately there's been nothing urgent, just a lot of "are you ok where you"s, but not been able to reply, grrr.
Not unlike every day at the clinic where I look, see, feel, but don't understand anything said to me, and can't communite with the patients. I at least can use pantomime, which doesn't work at the internet cafe, and meanwhile I'm sure my parents are wondering where the heck I am. But today it became clear that if I want to communitate with everyone, I need to learn Thai for getting around town, Burmese for some of the patients, Karen for the medics and the rest of the patients -- then there's Po Karen and another kind of Karen beginning with S-. At the guest house I have moved to, when I tried to order scrambled eggs from my Thai language book, the young guy serving me said, "Huh? what's that?" and "Oh, scrambled eggs," when I pointed to it on the menu. Turns out they're Burmese, but speak English pretty well.
Fortunely, the medics and midwives mostly speak some English, and it is with them I am working and trying to teach in any case, so it works out pretty well. Dan said before coming, he learned a bunch of Thai that he hasn't used and just works through the medics. Some of them stay at the clinic, others train here and go back to their refugee camps or villages in Burma. Today they made me lunch -- noodles with veggies and spices I couldn't identify. After they gave me coffee they complained I talked too fast and they couldn't understand me.
There's a training of the backpackers going on at the clinic this week, a lucky happenstance for me during my first week here as it happens twice a year, and is a big focus of the clinic. These are medics who each take a backpack with $2300 in supplies and give training to medics in Burma. The come back every six months for more supplies and training. Since the last training they lost two medics to landmines. I commented to one of the trainers that I would love to take a picture of the classroom full of these beautiful people in their long sarongs, and faces like serious students anywhere in the world, but I'd worry that it could be used as identification by the Burmese gov't. She said that there's a medic with history of jailtime due to dissident activity, who has a distinctive mole on his nose; when he goes out he has to put a bandaid or make-up over it.
Baffling to think that there ever could be oppression of a whole ethnic group. Spending just the past five days with these folks, I mean this is stating the obvious, but when you spend time with any "people", you just think of them as individuals, and some you like and some you don't. My general observation is that this is a culture of strong women, and sex equality in general. Most of the medics in my field and midwives are women, but there are at least three men counseling on family planning, and one who does births. Though, interesting in contrast, the fathers are not generally present in the delivery room, per Burmese norm. There was a father at the first birth I observed and he was very sweet and curious, and a lot less squeemish or nervous or wondering what HE can DO than many American fathers I've seen. He was just a nice presence for his wife having her first baby.
I'm learning lots about malaria, which I haven't seen before. There's a woman seven months pregnant, undergoing her seventh round of treatment, and clearly suffering from malaise. Usually one round of meds gets it, but Dan said he suspects it's retained in the placenta and keeps shedding parasites. I learned in one of the lectures for the backpackers that malaria causes anemia. To give an idea of the range of knowledge of the medics, when the lecturer asked, "How does malaria cause anemia" the responses were a) that the mosquito takes the blood, and b) "hemolysis" -- in English. That means it causes red blood cells to burst, for those of you who don't know as much as Burmese medic with a backpack.
Monday, January 26, 2004
I asked at my hostel what their monthly rate is, and the young women told me they have none. It appears they prefer guests not stay long term, in the case they have a large group coming in before or after a trek, although their English isn't perfect so I might have misunderstood. I will ask at the clinic whether ex-pats generally stay at the other hostels (which are more in town, noisier and not as nice structurally), or rent places. I will probably move to another hostel so as not to be too isolated, and since I don't know how long my arrangement with the clinic will actually last. Pity, I like the room here, but the staff are aloof, and frankly guests next door to me make a lot of noise!
Sunday, January 25, 2004
We woke up today to gunfire, or something. It began at 4AM. While I and a couple of others were taking our coffee on the verandah, we heard more of it, some drums beating, shouting, and then a dragon passed by the driveway. Happy Chinese Monkey New Year! The celebrations continue.
There were no prenatal patients scheduled for Sunday, and since I didn't know if the midwives in L&D would have heard about me yet, plus reasoning that I'd like to know more about the prenatal care of these women before hitting the more intense L&D scene, I decided to rent a bicycle (best $0.75 I ever spent) Sunday morning and see if I could find this Wat (temple) on my map 11km north of town.
To my delight, not too far out of town it becomes very villagey, and even somewhat less flat, if not actually hilly. It is clearly the dry season now, thought honestly I still have to look up whether this is considered hot or cold, since it seems about high 80s in the day and 50s at night. One advantage to being a New Yorker is I can tolerate extremes well.
As I biked along, I exchanged many smiles with people young and old either walking the streets, or headed the other direction on scooters. The children playing in front of their wood houses on stilts called out, Helloooooo! The families seem to live mostly in the enclosed upper stories, while the ground level is open and either inhabited by livestock, scooters, drying food, or maybe the dad's workbench and old record collections. It reminded me a bit of the carriage house I grew up in, where we would use the lower level either for roller skating or swimming.
I observed one comic episode where a bull in a pen tried unsuccessfully to mount a cow, and a kid (a cowherd, I guess you'd call him) came chasing after them to knock it off. The cow went running toward where the rickety lattice bamboo fence met the main sturdy wooden fence, and just broke through between them over to the vegetable patches. The cowherd chased after her, around the cabbages, around the irrigation pools, to the other end of the bamboo fence, where she broke back through to the cattle pasture. I couldn't help but laugh, wondering what good the fences were, and how smart that cow was. It must be that funny bump on the back that Asian cows have (I've heard it's fat, but it looks sturdy like bone, like an extra shoulder blade). Meanwhile the bull diligently dug a hole to nowhere in the ground with one horn.
I found a Wat, though perhaps not the one I saw on the map, and parked my bike. There was a tall, white pagoda structure, adorned with red and gold detailing, and a long staircase with steps painted pink leading up to it. Beside it was an open-air meeting space with a corrugated iron shelter overhead. On the stage in front sat a benevolent, larger-than life plaster Buddha sculpture painted brown, wearing saffron robes. I sat on one of the marble benches and read some writings of Aung San Suu Kyi, Burma's most well-known political dissident. Some kids rode by on a bike. One spotted me and started yelling, "Helloooooo! Oh my god! Oh my god! Helloooooo! Oh my god!"
Being just east of the border with Burma, I knew I could bike mostly north and west, and keep my bearings and probably not go too far without hitting a border patrol. An hour or so into the ride I found myself on a road with Thai flags lining one side, and a yellow flag with a picture of a wagon wheel (the Thai Rotary Club?) lining the other. I didn't know if this was possibly the Burmese flag, or a symbol of Chinese New Year. I didn't see any border patrols, though I did pass between what looked like two lookout towers and a gate like at a tollbooth, before entering a compact village of more houses on stilts. This may have been the Thai version of a gated community, but no one said more than hellooooo to me. This was the closest I could get on this ride to the low mountains just maybe a mile or two to the west. I wonder if they are reachable. I will ask around at the clinic.
Saturday, January 24, 2004
Dan made it sound like I could more or less come and go as I please, either come in the next day, Saturday, or wait 'til Monday. I decided as, heck, and jeez, what else did I have to do on Saturday? I didn't have a scooter to get out of town, or even a bicycle (yet) to check out the farther reaches. Besides, it's been months now that I haven't been in the midwifery world and truly I'm eager to get back to work.
I didn't quite remember what was where, but I found the RH (Reproductive Health) clinic, and introduced myself to some of the young women sitting at a table, flipping through charts. I don't know if they already knew who I was, or if they'd just seen more like me before, but they welcomed me to a seat. I picked up the chart in front of me, surprised and pleased to see it was a printed record much like the ACOG (American College of Obs & Gyns) one we modify for office use; the chart & notes were all in English.
A clinician welcomed me in to see a patient with her. I thought she said the patient was six weeks pregnant, so I formed a totally off-base opinion of what was going on when the clinician said she'd had bleeding last night, which in the first trimester (before 13 weeks) often means miscarriage. When she lay down on the table for the exam, her protruding belly clearly betrayed that this was more than 6 weeks – had she meant 6 months, or said 26 weeks?
The clinician measured her belly at 15 cm, which is the distance between the pubic bone and the top of the uterus. After 20 weeks this measurement in cm should be the same as weeks of pregnancy, with margin of error of 2cm; so 15 cm in my experience was meaningless. But a glance at the chart created more not less mystery: her due date was 10 months from her LMP (last menstrual period); her due date would date her at 19 weeks, her period at 23 weeks. I measured her abdomen and came up with 19cm. Whoever had decided on her due date had not indicated the basis for this in the chart (since it wasn't the LMP) but I agreed with them. We heard the fetal heart with the clinic dopler (hand-held ultrasound used only for this purpose), so we knew it wasn't a miscarriage, which only occurs once there's been a fetal demise.
I heard the voices of MDs I'd worked with advising me to do a pelvic exam since you can never trust a woman's report of amount of bleeding. But because of lack of resources at this clinic, plus the little intervention one can do with a 20 weeks pregnancy, we didn't do the pelvic, since she said there had been no more bleeding today. I advised the clinician to tell the woman not to have sex until her next month's visit (in case there was a low-lying placenta), and to return sooner if there was more bleeding. I also recommended no kick-boxing or step aerobics. Just kidding. I did realize later that I hadn't explained to the clinician about the low-lying placenta, which is the sort of teaching I am here to do.
A male clinician invited me in with him to the family planning room to advise a woman about tubal ligation. She had given birth two days before to her fourth child. I had nothing to add to what he told me he was telling her in Burmese, except to point out to her that her menstruation would eventually return, probably when she stopped breast feeding, but that she wouldn't be able to get pregnant again.
Between patients, I picked up a chart with a prenatal record from November '03 with a note saying: "Due date 9-03?? Probably wrong LMP. Diagnosis: full-term pregnancy. Plan: cervical sweep, return in 2 days for induction." I noted that on the chart the abdominal measurements were not linear (18, 28, 25…), if they were noted at all. I would need to make a note to stress the importance of making as accurate as possible an assessment of the dating of a pregnancy on the first visit. In my country (read that with a Transylvanian accent), we would do an ultrasound on first visit if presumed dating is after 6 weeks, but since that is not available here, and in two out of two cases I have seen inaccurate LMPs noted, size of the uterus with bimanual palpation would be especially important (depending on a skill of clinician); and a community effort (worldwide, come to think of it) should be made to educate women to keep records of their menstrual history.
A discussion in Burmese amongst three men at the table turned to me when they wanted to know what to call someone who does abortions. I said they're done by doctors or trained nurses in my country, as it is a surgical procedure that must be done by someone well-trained. It turns out they were looking for the term "abortionist", which I realized I had trouble coming up with since it's used "in my country" mainly by the anti-choice lobby, and therefore had unsavory connotations coming off my tongue. I made a note to wean the phrase "in my country" from my vocabulary.
The situation they were facing was a woman (whom I did not see) who had presented having been on the pill, missed three pills in a row, and went to a village "abortionist" a couple of days later, who that day performed some sort of internal procedure. She was here now with abdominal pain and a fever. Now, the proper advice would have been to begin a new pack of pills that day (and perhaps a higher dosage at "Day After pill" rate), to use condoms for 7 days, and to return for a pregnancy test in 6 weeks, after which an abortion could have been performed. There is absolutely nothing an abortionist could manually clean out of a uterus three days after a pill slip-up. Now this woman may have a punctured uterus, a septic abdomen, and a life-threatening infection. I will eventually discuss this case with Australian Dr. Dan, who says he does not perform abortions.
I lay in bed this morning thinking of situations I could face with this population. If a woman presents for the first time with an unknown LMP and an abdomen measuring 26cm, is she 26 weeks pregnant, or is she 33 weeks with a fetus with retarded development? If such a woman's fetus has ancephaly (no brain matter), and as such fetuses rarely put their mothers into labor, would the placenta get old and give out before we knew it, and the baby be stillborn?
Just as poignant, I hope some sort of comfortable room for laboring can be rigged up, other than the scary aluminum delivery room. Woe is any woman who comes in for a first time birth at 3 cm and has to stay there. Preferably we can send them all for a walk, and wiggle that baby on down the pelvis. But questions arise: what is the situation with linens and laundry? Are there laundry facilities, so women could maybe do alternative positions on a soft surface, so long as there's a way to do laundry without putting the launderer at risk of catching a blood-borne infection from the dirty sheets?
Then, who are the women I will be seeing in L&D anyhow? Are the healthy women all at home giving birth by themselves with their TBAs (traditional birth attendants)? Is it true after all, that these are sick women who need more than I can offer? I saw hemoglobin levels of 10.0 and 5.6 on the records (below 11.0 is considered anemic – 5.6 is dangerous); the women who come for appointments get iron tablets, but the others, how many will have a life-threatening hemorrhage?
Hot shower this morning for the first time in country – not at my $9/night plush hotel with swimming pool (cold water only in the budget rooms), but in the shared bathroom of this $2/night hostel. The morning was chilly so it was welcome. There was also more noise from traffic this AM than I've ever had in Brooklyn.
The No.4 Guest House was billed as the one to go to in Mae Sot for their knowledge of trekking in the area, and for their connection to the Mae Tao Clinic – that this is where to leave discarded clothing and medications to be distributed by professionals at the clinic or refugee camps. There is a box in front welcoming donations. But the staff is aloof, even when guests labor with Thai-English phrase books. They tell me there's an MTC office in town but it's only open at night, which strikes me as unlikely. They can't tell me either where this office or the clinic itself is located.
I wandered town for about 10 minutes before I realize it's unlikely any NGO or the MTC would have a sign posted out front for their headquarters, advertising their presence in this town overrun with Thai police and militia. Moreover, everything in this town except "massage", "guest house" or "Coca-Cola" is written in pretty but incomprehensible Thai squiggly letters. I plopped down for a breakfast of ramen noodle soup (with chopped-up greens), and made faces at the little girl in yellow pajamas. I guess this is what dorky grandmothers do (sorry mom), but I showed the serving gal a photo of my two nieces, screaming their heads off on a wild tire-swing ride last summer. The restaurant ladies passed it around and puzzled at the wide-mouthed expressions, hilariously mimicking them; "cute but weird" seems to be their consensus. Over the ovaltine, I recognized my trepidation about going right to the camps or clinics as they say "tourists" are no longer allowed tours. I realized I was still inclining toward useless, remote administrators. I have one option.
Friday, January 23, 2004
Considering I will now be faced with learning Thai to navigate the people, shops and restaurants in town, and Burmese to navigate the clinic, I'm not sure what to do next. I couldn't find any English-Burmese language books in town, and besides, I doubt there's a Lonely Planet Karen Dialect phrasebook in print. Hopefully I can find some good tutoring.
Later in town, I ran into Brita, the Western woman I first saw at the clinic. She sat in front of her laptop at her guest house café, her bobbed brown hair is held back by surfer sunglasses. She's here with a conference of medical types who are here to train Backpacker Health Workers – Burmese folks who take a $2300 kit of medical supplies into the jungles of Burma and administer health care to the ethnic minorities, who get no other medical care while they pursue revolution against (or avoid annihilation by) the repressive Burmese government, which since 1962 has turned Burma from the most economically promising Asian country into one of the poorest in the world.
One segment of this conference will be teaching the medics to perform surgeries, demonstrating on pig carcass. Brita is just setting up a curriculum of what to teach the backpackers about reproductive health. I ran down with her the list I had written out that afternoon while waiting for Dr. Cynthia, of what I normally do in ante-partum visits. She was interested but didn't take any notes. She is in for this conference from Nepal, where she is doing field work for her Ph.D. in public health. She claims to be pretty non-medical and isn't really sure what they're asking her to write up, since she isn't the medical person who knows what needs to be taught. I give her some ideas, but as I don't know what else not to expect to be able to do (STD testing? healthy lifestyles advice? nutrition to starving jungle-dwellers?), we're both at a bit of a loss. Big learning curve ahead.
I must get over my tendency to assume that because it's on the same map, and because the scale in the corner says ]----------[ this is 100m, that I can walk it in a reasonable amount of time. It's true I made it to No.4 from the bus station in once piece, but with luggage for 6 months that included 10 books, hiking boots and my midwifery gear, I was thanking my lucky stars I didn't make any wrong turns.
So this morning I followed the road west out of town past No.4 toward the Burma border. And walked to the Burma border. There was a big air-con Thai Tours bus parked to the side, and a bunch of elderly Swedish tourists perusing the racks of wicker baskets. There were also plenty of camouflaged men, so blended in with the tourists and made my way back toward Thailand. This walk to the border took about an hour, and I was knackered. I caught little bus thing—fortunately there's no direction it could have gone except back to Mae Sot, so I told the guy I wanted to go to Mae Tao. He replied, Clinica. I said yes.
I'm still not sure how discrete I have to be about the Clinica. The books say the Thai gov't recently recognized it, but others say that it may soon be shut down to appease the hostile Burma SLORC dictatorial govt. Anything that draws attention to the clinic is bad. Mae Sot is crawling with Traffic Police and Customs Police. Will a New Yorker in an Ozzie bush hat wandering around town for longer than most tourists attract attention?
The bus-thingy dropped me at a driveway I had passed in the first fifth of my trek to the border. It appeared to be a sort of open-aired compound, with buildings around a central dirt and gravel clearing. I wandered from "Information" to "Registration", asking for someone my friend Elle at an NYC NGO had contacted on my behalf. Finally I saw a western woman, thinking it might be she, but she turned out to have just gotten her herself that day. I explained to a small group of women that I am a midwife, possibly here to work at the Clinic. I was ushered right in to meet Dr. Cynthia.
Dr. Cynthia had three or four people orbiting around her the whole time I was there. She was calm, perhaps a little tired, but indulgent as the man across the table from her laughed hysterically as he recounts a long story in Burmese. Dr. Cynthia reminded me a bit of a Latina woman, Adrianna, who works at my food coop in Brooklyn, whose attitude is (sometimes), "Please be taking up my time right now with something of substance."
I explained that I had been in contact with the Clinic through Doctors of the World, and that while I had not been guaranteed a position, they had told me the Clinic could possibly use the help of a midwife. She took my c.v. and had it copied, and glanced at it occasionally, "…ah Columbia…" while she conferred with some other folks on other matters. She asked me few questions and eventually presented me to another woman, a Burmese midwife, who showed me to another part of the compound where she passed me along to someone else, who passed me along to an Australian MD, introducing me as a student.
Dr. Dan, who looks about 30, and clean-shaven maybe 8 days ago, gave me a thorough orientation and introduction as he showed me the different wards. In the RH (reproductive health) inpatient ward, there was a full house of women on wooden table-beds with linoleum covering, about three feet off the floor. There were a few men and children hanging around the women who were inpatients there. The delivery room was a scary scene of aluminum tables and stirrups, reminding me more a kitchen in a French horror flick. Dan said they don't use the stirrups much (thank god). But still, it's a yucky room. I wonder if I'll be able to get the women up and walking and out of this room as much as possible. I wonder if these metal tables can facilitate position changes (side-lying, on hands & knees) instead of Louis XIV-style on-your-back?
Dan told me about the 100 or so "medics" who essentially run the place, while they're in training, before they take their skills to the refugee camps or back to Burma. They are the ones you must have a good rapport with if you want to help; otherwise they'll "yes" you and go about whatever they'd rather do. Makes sense, as this is their clinic, and anything can be excused on a cultural basis. But a good rapport with staff always makes life more pleasant all around, and especially here when my Burmese isn't so great.
The Clinic itself is not a refugee camp, nor is it in one. It seems to take some complicated maneuvering, getting the woman from a camp or from Burma to the Clinic. Some come from "far, far into Burma," says Dan. Such as the woman who came in yesterday and gave birth to a 1.067 kilo preemie two days ago, "See, it's right over there on the bed, hooked up to an IV, lying next to its mother," Dan points out. That's less than two and a half pounds. There is no incubator at the Clinic.
We take a look at the postpartum area, the inpatient trauma ward (mostly male patients), the inpatient medical ward, but bypass the outpatient area, which he tells me is like any E.R., treating colds and ankle sprains. We discuss the limitations of facilities I would expect, such as no ultrasound, no fetal monitoring, no microscope. He says they don't do pap smears because they haven't the facilities to follow up on them – no chemo, no radiation. If, for example, there's a woman in her 60s with an obvious mass, they will tell her to go seek her traditional medicine. They do send some women to the Mae Sod Hospital for c-sections occasionally, but it causes great expense to the clinic.
Dan is the doctor I was told was the obstetrician who would make my presence here redundant, but he is in fact a generalist with some OB specialization. He also tells me that there will be a German midwife coming back for her annual month-long visit starting next week. But while his area is general medicine (diagnosing and treating tetanus, e.g.), and the German midwife doesn't do births but rather concentrates on family planning and contraception, I would fit in my own niche quite nicely, with none of us stepping on each others' toes, as he said happens when there are too many Docs about.
Dan tells me he and his wife get around on bikes and motor scooters; live in a guest house in town; didn't get rabies vaccination; is not taking malarial prophylaxis and doesn't recommend it as it doesn't work on these mozzies, and besides, he's heard a rumor that Mae Sot is malaria-free, but doesn't believe it. He works 5-7 days a week, but it's not a huge pace. He and his wife get away now and then.
After my tour I stopped back in to see Dr. Cynthia, who has gone off somewhere. I told her proxy that I would be very interested in coming to work at the clinic, and ought I speak to Dr. Cynthia again, but she waved me off, saying Dr. Cynthia had already said it was alright and that's why I met the MD and everything. Wow, I could have come here three months ago!
Thursday, January 22, 2004
The No.4 Guest House is a wonderful teak house made just right for the tropics – high ceilings, woven-grass inner walls, large doors that open almost entire walls onto verandahs in front and back. Ironically, they claim to be the first guest house in the area.
It's the last one out of town, on the western edge on the way to Burma. I expected Mae Sot to be what you envision when you envision "village", but it's really more like "town", as in, the New Jersey part of Chinatown. Loud motor scooters vie for dominance on the narrow roads with SUVs and pickups. Every storefront has a Coca-Cola case and a plethora of plastic baskets and Tupperware (spell-check made me capitalize that), rubber flip-flops, nylon bags and laundry detergent. Or scooter-repair supplies. Then, there are the ones with vegetables in the showcase next to the lady at the wok, whipping up something that burns my eyes as I walk by.
Past the golden temple, past the tangle of electrical wires hanging at the level of my head, past the sleeping dog, I found No.4 Guest House, 100m back from the road. I spent some evening chat time and dinner with fellow No.4 guests, Monica and Sean, who told me they spent the afternoon chatting with a rep. of the Thai Consortium they found by email, hoping to find some volunteer work here in the middle of their trip around the country. They were told the could get on a waiting list to teach some English at the refugee camps several miles from here up and down the river, but that if they had some medical training, they'd be lucky to get on the waiting list at Dr. Cynthia's clinic – a.k.a. the Mae Tao Clinic. Monica asked if I'd contacted anyone by email before coming up here, and, poor thing, I gave her the "Honey I must have sent 80 emails and made scores of telephone calls, and I'll show you what I got" rant.
These were a couple of 27 yr. olds, considering grad school vs. Peace Corps vs. marriage vs. career changes. The perfect time to go traveling, I believe I can say as an expert. Monica said she was thinking about MSF-type nursing. She asked me for an earful, which I gladly gave.
Last minute decision, I decide to take the daytime bus to Mae Sot so I can a) see the countryside so I know what's between here and there, b) read some of the 4 Burma books I'm lugging around, c) save 90% on the airfare (yes, shut up, it's $7 vs. $70), and d) not lose the arrival day to overnight-bus lag feeling horrible after an uncomfortable night of snoring seatmate and aching back etc. come on I'm not 24 anymore!
Waiting for the bus to leave Bangkok I was stunned to see my friends Antje, Chris and their 3-month old daughter Clara on the front page of the International Herald Tribune. I knew Antje had had trouble just before Christmas returning to the States from Germany on a trip to introduce her new baby to the family. The ordeal immigrants have to face in the States is deplorable at best. Don’t get me started on miserable failures!
http://www.iht.com/articles/125919.html
http://www.nytimes.com/2004/01/21/nyregion/21detain.html
My seat mate introduces himself first thing, Hi I'm Wonchai, I'm a policeman. I reply, Hi, I'm Melissa, I'm a tourist seeing the beautiful country of Thailand. This pleases him, and we have a friendly conversation much of the ride up, exchanging mints, him correcting my pronunciation. He tells me he is on his way to Mae Sot to investigate violations of the legal limit of currency transport across the border with Burma. I tell him I want to see the mountains of the north of the country. snicker, snicker.
Actually it's true, I'm eager to see the mountains, and perhaps eventually to do some trekking. I see, to my surprise that the country is extremely flat, at least the mainland part. They say Thailand looks like the head of an elephant, facing left, with trunk the long peninsula that is split with Burma on the upper half, and Malaysia the bottom quarter-ish. Bangkok is on Dumbo's chin, Ko Samet is where the tonsils would be if they were inflamed, and Mae Sot is around the eyeball area. Halfway to the cheekbones is Tak, west of which grows foothills then real hills that make our ears pop.
As far as Tak, it's flatter than Kansas, and even drier. I remember harkening back to the 1988 trip my family took to China and Thailand, comparing flat, humid, boggy central Florida to Thailand. But now to my surprise I find not only that it's awfully dry, it's not boggy, wild or even farmlands. In fact, it now reminds me of northern New Jersey, with major highway development including overpass superstructures, billboards, roadside attractions, litter everywhere, construction like it's June on the East Coast, and electrical wires detailing every mile like a carefully embroidered lace fringe, enough for a decorative border (or carefully-placed asymmetrical division) to any snapshot of the countryside. Pity. Not much at all to look at, really.
I practiced a few phrases from my phrasebook on Wonchai, and after several repeats with him feigning amusement and comprehension, he would then repeat what I was trying to say, and compliment my accent. In one excellent Burma book I'm reading, written by a member of the Karen hill tribe, the author describes his grandmother's description of her experience of England in the 1920s, to which she was invited to be a "venue" in a traveling circus. She reported, "People always say, 'Hello,' 'How are you?' and 'Goodbye.' They never ask, 'Have you eaten yet? When will you take your bath?'" These are apparently still common greetings in this part of the world. After a 25 minute break at a rest stop where we cashed in the bonus meal tickets that were part of the bus ride, I pulled out a phrase from the book and tried it on Wonchai as we got back to the bus: "Thaan khao laew reu yang?" or, "Have you eaten yet?" He roared with laughter and made sure everyone else in the back of the bus knew the farang (foreigner) had asked, "Thaan khao laew reu yang?" People craned their necks and gave me smiles.
About 10 minutes to our arrival in Mae Sot, we were stopped at a police checkpoint. The 6-10 men in camouflage regalia were seated in beach chairs under red Coca-Cola beach umbrellas, on the center line of the road stopping vehicles going both directions. I watched as a woman leaned across the driver of a car going in the opposite direction to us, laughingly gave the men what looked like a bag of dinner mints, and carried on their way. The next car gave them a newspaper, and the third car gave them nothing, and both sped on. My seatmate nudged me and told me to get out my passport – the military men had boarded the bus. They shepherded out about seven men and women from the front of the bus. Everyone was silent. My policeman was sitting eyes forward, boring holes in the seat in front of him. Impossible for me to read emotions in anyone's face. In a Hollywood movie it would have been much clearer if the police, disembarquees or fellow passengers were gleeful, vindictive, bullying, impassive, frightened, angry, or merely weary. Nobody looked at my passport, or indeed, at me.
Policeman said nothing as we drive on, didn't look at me. I asked quietly, "Thai people?" Shook his head. "Burma people?" Nod. Didn't look at me: no further questions. He did, however, give me his phone number before we disembarqued. I joked, I hope I won’t be needing a policeman! Somehow it wasn’t so funny.
Wednesday, January 21, 2004
Anong, the middle-aged hostess at the Atlanta Hotel restaurant, had offered last week to go with me to see Wat Pho, the temple in with the enormous reclining Buddha. I tried last night to her up on her invitation to, however she would be traveling today for Chinese New Year, but suggested perhaps we could go when we both got back to BKK. That would be a number of months yet, at least on my end. Pity, though, I'd like to have seen it with her. I spent the day getting my own bus ticket out of town, seeing the Wat and Buddha on my own, and taking on foot too many of the deceptively long distances between points on my Lonely Planet maps.
Today's Thai food lesson: those long skinny green things in the curry are not green beans! and, those explosive bombs of culinary pain hide amongst the coriander stalks too, so do not take your eyes off your food as you eat, or they'll get you, too.
Tuesday, January 20, 2004
The email from the secretary of MSF Docteur Francois, the not-so-cute administrative type, said, We have nothing for you at this time, if we a position does open up we will contact you through the New York office where you have applied. I decided to reassess my options.
Plan B (or, what am I up to, plan G?) had been to go to Chiang Mai, the city in the north of Thailand, where the NGOs would have their regional offices. But such offices would surely have more Docteur Francois administrative types who wouldn't necessarily know what they needed on the field and probably wouldn't refer me elsewhere, as no one else had so far. I spent the day navigating the Bangkok Hospital system to get my final Japanese Encephalitis vaccination. The doc there spoke very good English, and guessed, from my profession and my timetable, that I was heading north to help with the refugees. He took my email address and eventually passed along to me a third-hand connection to a refugee camp. Bangkok hospital reminded me of Methodist Hospital in Brooklyn, except it was friendlier, more efficient, and way cheaper.
Monday, January 19, 2004
Ko Samet is apparently where Thais leave their unwanted dogs. This island has more dogs than Paris and the Upper East Side combined. In contrast, however, these are apparently the non-shitting kind of dog, as I did not see, smell nor step in a single pile over 3 days. I'm not sure what mange is, but I'm sure these mutts had it. I'm also sure that the phrase "mangy cur" has its origins in Thai.
Apart from that, my weekend mainly consisted of swimming, avoiding the sun, a little windsurfing, and trying to decode the dynamics between the infestation of couples on the island: primarily Western men and Thai women. Even at the airport, I found myself curling my lip at all the single white men in their 40s and 50s. There were many of these fellows, walking around with skimpily- (but not really scantily-) clad Thai gals all over Bangkok, all of them holding hands, which is strictly against Thai etiquette. The gals seemed to be of a range of ages, often young 20s-looking, but many older, perhaps up to late 30s. Of course everyone knows about the tourist sex industry in S.E.Asia.
The dynamic between many of them did not necessarily suggest prostitute-John, though it was quite baffling to me, the sheer number of these couples, often mis-matched in age, and never Western woman-Thai man. Moreover, it appeared more than likely that these couples came together to this weekend resort island. Perhaps rather than feel constantly disgusted by presuming exploitation of all these Thai women I am ignoring blatant evidence of it through rose-colored glasses. But eventually I remembered reading that Western companies often send their single men to overseas positions such as in Bangkok. Possibly that these were in fact truly romantic couples. Hey come on, I can't read books on Burmese history all day!
Over dinner one night I learned an important lesson: never order anything from a Thai menu that calls itself "spicy". That night I had a papaya salad that scorched my tonsils. But the "spicy Thai soup" was an endorphin-releasing experience. If I could get to the bottom of this, I would not need pain meds if I am ever in labor. The Ozzie couple at the next table was laughing at me. I think it was the flames shooting out of my ears. Some cartoonist was clearly in Thailand when that image was divined.
My theory has been that chili peppers at every meal make for a healthy digestive system while traveling. I had none my first two days in Ouagadougou during which I gorged myself at the wedding banquet, and for the next two felt like an abused tube of toothpaste. Henceforth I never ate without the chili sauce, and even the roadside vendors who were surely serving us vultures couldn't offend my systems.
However, I worry about preserving my sense of taste, just a bit. Am considering instead swallowing a handful of chilies therapeutically with every meal.
Thursday, January 15, 2004
After some sleep recovery and time spent in bookstores learning enough Thai to show that I could, it was time to set about my mission. The morning consisted of an unconventional tour of Bangkok and beyond as I hunted down the offices of MSF headquarters. The address I found on the web was outside the borders of the Lonely Planet travel guide street maps. I flagged down a cab who had no idea where I wanted to go, so I, the tourist, had to conjure directions on likely highways for the local cab driver. Then it was 20 baht, 40 baht, 25 baht at token booths every few miles. It seems the entire highway system is raised off the ground, over avenues and neighborhoods, much like the BQE. We even dead stopped for 10 minutes, just like at home.
We did eventually find the town and even the street of the address, but the cab driver was ready to let me off in front of the daycare center, which obviously wasn't it. After help from the nursery matron and more circling, we did find the address I had but it seemed to be of a private residence. A Thai boy in his teens came out to tell me that Mr. So-and-so was out of the country until next week, could I please come back then and in fact it would be better to call here's his card. Fact is, I'd had three months of calls and emails not being returned, so there was nothing that would get me to do other than show up in person at any of these places now that I was freakin' already here on the other side of the world.
Nearly an hour and a half later, and at about 480 baht (US$12), the cab dropped me back in Bangkok in the vicinity of the BBC (Burmese Border Consortium). This office took some wandering to find as well as it was not marked from the street, but only with a small sign on the door of the building, which was down an alley behind some restaurants. This is presumably because it is illegal in Thailand to aid or abet illegal immigrants, which includes a good portion of Burmese refugees. All the literature says it is important that nothing call attention to the refugee camps as they are under constant threat of being raided by Thai authorities.
At the BBC after asking to speak with someone who might help me find an organization with whom to volunteer my professional medical services, the secretary helpfully handed me a book of laminated pages of NGOs and left sight. I copied down several, including that of the MSF office, which looked to be about a 10 minute walk from my hotel.
Presently, though by the time I got there it was lunch hour(s), I met cute young Docteur Francois, who said he was in charge of MSF operations in Thailand, and that he has already been in country for a whole week. We chatted for a while, I gave him my c.v. telling him if there was a chance I could work with MSF I'd wait in Bangkok with my lungs filling up with exhaust for a whole month. He said he'd get back to me within a week and left me with a smile full of promise.
Certain that I couldn't bear to wait out the weekend while my vital organs corroded in the city, I booked a ticket on a van to an island three hours away. I might as well wait in internet cafes on a desert island, if that's how it was going to me. Little did I know that Dr. Francois would contact me via email just hours later.
I spent last season cruising the internet for NGOs, writing scores of emails and making dozens of phone calls in an effort to find an organization through which I could work as a midwife in a developing nation. It's been a goal of mine ever since I read in the newspapers about the work of Doctors Without Borders, or MSF (Medecins Sans Frontieres), with the Kurds during the first Gulf War back in the early 90s, and in fact one of the motivating factors in my decision to become a midwife.
When I applied with MSF after finishing midwifery school in 2001, they first offered me a spot in Sri Lanka, which I was so ready to grab I bought Lonely Planet Sri Lanka and cut my hair. But then they changed their offer to Angola, which seemed a bit too hard core for me just out of school. Now two years later, between jobs and between boyfriends, thinking if ever I were to GO this would be the time, I applied again. They offered Angola again; sensing my reticence, they also offered Congo. Both these countries are in civil war, Angola has ebola virus and rabid wolves; and Congo has rabid militia that attack villages, eat their victims and feed them under threat of death to the surviving relatives.
I visited Western Africa a year ago for the wedding of my friend the archaeologist who was marrying a diplomat. While in Ouagadougou, Burkina Faso, I had been warned constantly not to wander around by myself for fear of assault. Although I had gotten over much of my fear factor by the end of 12 days there, it was persistently disturbing to me how aggressive people were, albeit generally in a friendly way. I am a normal-to-tall woman by western standards, yet it was intimidating to me how pushy shopkeepers were, and how every person on the street stuck out their hand to shake mine. I returned handshakes obligingly, but wiped my hand with alcohol swabs when I could. There had been an outbreak of meningitis shortly before I got there in which 350 people in Ouagadougou had died, and I'd barely had time to get my immunization before leaving. All said, I wasn't keen on a suicide mission to sub-Saharan Africa.
The next most promising lead I got was from Doctors of the World, or MDM (Medicins du Monde) with a connection to a clinic in Thailand working with Burmese refugees. Following this up diligently via email with an administrator of the clinic, I was told that there was an OB/GYN at the clinic until next June and so most likely wouldn't need me. Keeping a smile in my pixels I emailed back through gritted teeth that an OB/GYN and midwife are not redundant and can in fact collaborate quite well together. I received back neither yay nor nay, and from MDM neither promises nor discouragement.
By this time my bum was plenty sore from long hours in front of the internet (I don't have a fancy Aeron chair). At least I knew of a population in need. Why hadn't I thought of web searching "refugees"? Of course, I had started my search back in early fall hell-bent on helping Tibetan refugees, not realizing how fashionable this population was – as in, please don't send us any more volunteers we don't know what to do with them and they won't go away. Refugees are needy people, usually located in friendly places, so it makes for a perfect setting for folks wanting to volunteer services, not self-sacrificingly. I bought a ticket to Bangkok. One-way.
Tuesday, January 13, 2004
Breakfast at the Atlanta Hotel is my first challenge. The menus is voluminous -- entertaining as well as educational reading. With some trepidation I order the Traditional Thai Breakfast: rice congee with choice of three out of seven. I take the scrambled egg, pickled radish with Thai omelette, and pickled radish with chillies. And The Atlanta Grand Cappucino. After 24 hrs flying time, including an unscheduled emergency landing in Anchorage to decant a sick passenger, and a stopover in Tokyo (20 minutes, not 3 hrs, due to the Alaska stop) during which I ran to my connection (and forgot ever to look out the window to check out the skyline) -- after this, one cappucino is not enough, I follow it with The Atlanta Serious Coffee. Dizzy, bleary, but not sleepy.
Thailand is 12 hrs ahead of NYC, and crossing the int'l date line, 24 hrs travel cost me 36, during which I slept, read & ate at will, not bothering to do the math with my watch. I did not need to change my watch: thank you analog dials.
Rice congee comes in a big bowl: it is rice made with twice too much water swimming in its own juices. I look at it, and the plate divided in three with each of my choices, not quite knowing what to do. The Atlanta has a No Complaints -- Not At These Prices policy, so I read a little tenuousness, if not distaste, in her face when I flag over the 50's-ish server. I ask her, with a little pantomime, how Thai people eat this. She lights up and becomes positively maternal, taking my spoon, skimming a little rice & some broth, handing it to me. I eat it. She takes back my spoon, scoops up some scrambled egg, drops it on the congee, skims it back up and hands it to me. I eat it. Scrambled eggs with rice, yum, just like leftovers at home. She takes back my spoon, scoops up some pickled radish with Thai omelette (which is scrambled eggs), hands it back to me and I eat it. Vinegary eggs and radish with rice for breakfast, double yum!
I look around and note that of the five parties in the cafe, I am the only one not eating plain eggs on toast. I am not smug (yah right).
When the server leaves me on my own, I repeat the routine, adding some sliced chillies on top of the egg. Tasty, fun food. I think I have down the pat the protocol for proper eating of rice congee. And on a good day, one serving will only take me ninety minutes to eat.
Monday, January 12, 2004
My first impression of Thailand, just off the airplane at midnight, is how much it smells like Indonesia. This is a common sensation when traveling, I think: many things remind one of something else, people on the street causing double takes to people one has known before. It hits me again when I get out of the taxi at my hotel: the hot, humid, distinctly smokey smell I associate with Indonesia is strong.
There is a sign posted prominently outside the Atlanta Hotel: No Sex Tourists Allowed. So much for the helpful advice of my friends for this lonely traveler: hooking up with locals. It is 2am by the time I check in and the staff are perky, friendly and welcoming.
