The old temple in Sangkhla- submerged for most of the year.
Sunday, May 15, 2005
I've got my own internet connection working so can get the much-requested photos onto the blog! It's bug season at the moment - they are everywhere, including in every drink and meal - so to start, here's one killed and arranged specially. I was very grateful that this jumped out of my towel (while I was drying myself) rather than attacking!
Friday, May 13, 2005
What I'm not talking about
A 5-year old girl died on 31 March 2005.
She was my patient for the last hour of her life. On the way back from the village, we came to the clinic she had been in for the previous day. She looked terrible, and we put her in the truck to take her to the hospital.
She died 10 minutes before we got there.
Some of you will already know about her. For the rest, I’ve been trying to find a way to talk about it:
There’s the medical way –
She had been comatose all day, with tachycardia, convulsions, no urine output, severe hypoglycaemia and a falling haemoglobin. She had been treated for pneumonia but most likely had unrecognised severe malaria.
But this girl is more than her last 24 hours.
The Hollywood way –
Doing CPR in the back of a speeding 4WD ute, the IV swinging off the bamboo pole, being waved through army checkpoints as they realise what is happening…
But she didn’t wake up.
The shocking way –
Feeling her face against mine as for the first time I do actual mouth-to-mouth resuscitation. The smell of her vomit. Her pupils which don’t react. Her body lolling limply as I pick her up to return her to her mother. Her bright blue dress which makes her look as she should be running in the street – as she was a few days before.
But this is part of life, and death.
The emotive way –
Watching the sun set in silence as her distraught mother, exhausted from crying, clings to my arm all the way back to Sangkhla.
But as much as this made me weep, it is not my loss to appropriate for my own story.
The bottom line is, a 5 year-old girl died of a disease that we can treat. I am involved because I was there, and my own and others’ actions may have helped, or not. She shouldn’t have died.
She is special, but she is just as special as every one of the millions of children who die of treatable diseases every year. And most of the world couldn’t care less.
She was my patient for the last hour of her life. On the way back from the village, we came to the clinic she had been in for the previous day. She looked terrible, and we put her in the truck to take her to the hospital.
She died 10 minutes before we got there.
Some of you will already know about her. For the rest, I’ve been trying to find a way to talk about it:
There’s the medical way –
She had been comatose all day, with tachycardia, convulsions, no urine output, severe hypoglycaemia and a falling haemoglobin. She had been treated for pneumonia but most likely had unrecognised severe malaria.
But this girl is more than her last 24 hours.
The Hollywood way –
Doing CPR in the back of a speeding 4WD ute, the IV swinging off the bamboo pole, being waved through army checkpoints as they realise what is happening…
But she didn’t wake up.
The shocking way –
Feeling her face against mine as for the first time I do actual mouth-to-mouth resuscitation. The smell of her vomit. Her pupils which don’t react. Her body lolling limply as I pick her up to return her to her mother. Her bright blue dress which makes her look as she should be running in the street – as she was a few days before.
But this is part of life, and death.
The emotive way –
Watching the sun set in silence as her distraught mother, exhausted from crying, clings to my arm all the way back to Sangkhla.
But as much as this made me weep, it is not my loss to appropriate for my own story.
The bottom line is, a 5 year-old girl died of a disease that we can treat. I am involved because I was there, and my own and others’ actions may have helped, or not. She shouldn’t have died.
She is special, but she is just as special as every one of the millions of children who die of treatable diseases every year. And most of the world couldn’t care less.
Sunday, May 01, 2005
Recommended reading
Anyone who wants to know a little more about the people I'm working with, read:
Singing to the Dead
Victoria Armour-Hileman
ISBN 0-8203-2358-6
Hope it will be available in Aussie libraries (or there's always Amazon if you're really keen!). The events are the recent history of my patients, and unfortunately are current for some. The author also says some interesting things about the world of volunteers!
Singing to the Dead
Victoria Armour-Hileman
ISBN 0-8203-2358-6
Hope it will be available in Aussie libraries (or there's always Amazon if you're really keen!). The events are the recent history of my patients, and unfortunately are current for some. The author also says some interesting things about the world of volunteers!
ANZAC day
I've gone all patriotic.
After reading the transcription of my grandfather's diary, and some changes of plans that allowed me the time, I managed to make it to Hellfire Pass for the dawn service.
My grandfather spent 8 months (of 3 years POW) working on the "Death Railway". He mentions a few places - Wampoh, Kinsayok, Kamburi, Rin Tin - in his diary, and I have been able to place these. He then talks in miles, and my brief calculations make me think that he was based around Sangkhla. He talks of friends dying, and working 15-hour days in boiling heat with no tools. The grandfather of one of our local staff died making this railway; the Thai, Mon and Burmese people are not often mentioned in our Australian memorials.
So, I stayed overnight in the only available hotel nearby, with busloads of other Aussies on group tours (a cultural shock in itself). We left at 4 for Hellfire Pass.
The site is at the end of the cutting through the rock, and you walk down about 200 stairs to get into the cutting. The path was lined with bamboo lanterns and we were each given a candle at the start.
So, at 5am on a humid Thailand morning, I followed a line of glowing candles into the dark of the cutting. 62 years ago the torches that gave the place its name burned here, and 700 of 1000 prisoners died making this short break in the rock. About 400 of us came to remember, and when the Thai soldiers played the Last Post, I admit that the tears came to my eyes.
So, Grandpa, even though you didn't talk about it and, as a teenager, I didn't get to know you very well, I am trying to understand a little what it must have been like.
If any of the Lowes clan want more details about the places, or can help me piecing things together, please email me.
After reading the transcription of my grandfather's diary, and some changes of plans that allowed me the time, I managed to make it to Hellfire Pass for the dawn service.
My grandfather spent 8 months (of 3 years POW) working on the "Death Railway". He mentions a few places - Wampoh, Kinsayok, Kamburi, Rin Tin - in his diary, and I have been able to place these. He then talks in miles, and my brief calculations make me think that he was based around Sangkhla. He talks of friends dying, and working 15-hour days in boiling heat with no tools. The grandfather of one of our local staff died making this railway; the Thai, Mon and Burmese people are not often mentioned in our Australian memorials.
So, I stayed overnight in the only available hotel nearby, with busloads of other Aussies on group tours (a cultural shock in itself). We left at 4 for Hellfire Pass.
The site is at the end of the cutting through the rock, and you walk down about 200 stairs to get into the cutting. The path was lined with bamboo lanterns and we were each given a candle at the start.
So, at 5am on a humid Thailand morning, I followed a line of glowing candles into the dark of the cutting. 62 years ago the torches that gave the place its name burned here, and 700 of 1000 prisoners died making this short break in the rock. About 400 of us came to remember, and when the Thai soldiers played the Last Post, I admit that the tears came to my eyes.
So, Grandpa, even though you didn't talk about it and, as a teenager, I didn't get to know you very well, I am trying to understand a little what it must have been like.
If any of the Lowes clan want more details about the places, or can help me piecing things together, please email me.
Wednesday, April 20, 2005
Get out the violins...
Last time, over the 11 days in the village I managed to:
Fall down in the waterfall, getting completely soaked and perhaps bruising the bones in my hand (I still couldn’t lean on it 10 days later)
Slip into a rock and tear off part of my toenail (see lovely picture later!)
Fall into the corner of a shelf
Burn my hand with hot tea
Fall backwards off a ladder into a house
Get attacked by a fierce palm, with hooks in the leaves
Do a spectacular comic-book style slip on a papaya peel, resulting in my first grazed knee since I was about 10.
I’m sure I’m already known as the doctor who is always hurting herself. It’s nothing new; I think it’s my usual clumsiness mixed with a different environment. I’m rather proud that I managed to avoid going through a bamboo floor!
Fall down in the waterfall, getting completely soaked and perhaps bruising the bones in my hand (I still couldn’t lean on it 10 days later)
Slip into a rock and tear off part of my toenail (see lovely picture later!)
Fall into the corner of a shelf
Burn my hand with hot tea
Fall backwards off a ladder into a house
Get attacked by a fierce palm, with hooks in the leaves
Do a spectacular comic-book style slip on a papaya peel, resulting in my first grazed knee since I was about 10.
I’m sure I’m already known as the doctor who is always hurting herself. It’s nothing new; I think it’s my usual clumsiness mixed with a different environment. I’m rather proud that I managed to avoid going through a bamboo floor!
Sunday, April 17, 2005
Songkran
Every civilised hot country should have a water festival.
It's now been Songkran for 5 days - usually only three, but conveniently attached to a weekend. Especially exciting for me as we missed Easter.
We've been invited to three separate Songkran "lunches" at 9:30 am, which means you don't have to eat again until 6. One of them was followed by a couple of hours of waterfights with the hostess's three kids, and then riding through the Mon area of town on the back of a ute equipped with two large barrels of water and about 10 water pistols between 4 of us (the only time weapons are acceptable in an MSF vehicle!). Groups of people stand at the side of the road ready to attack anyone who passes nearby and were especially excited to attack a group of "ingkloi" who fought back! I did get my hair involuntarily shampooed, but otherwise we managed to give as good as we got.
The rest of our break has been spent on a raft-house in the middle of the lake, swimming, zipping around the lake to various restaurants and the (usually submerged) Old Temple, and generally doing nothing. We've had a few issues after a big storm took out the power for 24 hours (lots of frantically packing vaccines into cool boxes and back again into the fridge) but otherwise it's been wonderfully relaxing. The new doctor, Sophie, has arrived, so once Violaine leaves next week it'll be the three of us (Sophie, Christian & me) from here to September.
It's now been Songkran for 5 days - usually only three, but conveniently attached to a weekend. Especially exciting for me as we missed Easter.
We've been invited to three separate Songkran "lunches" at 9:30 am, which means you don't have to eat again until 6. One of them was followed by a couple of hours of waterfights with the hostess's three kids, and then riding through the Mon area of town on the back of a ute equipped with two large barrels of water and about 10 water pistols between 4 of us (the only time weapons are acceptable in an MSF vehicle!). Groups of people stand at the side of the road ready to attack anyone who passes nearby and were especially excited to attack a group of "ingkloi" who fought back! I did get my hair involuntarily shampooed, but otherwise we managed to give as good as we got.
The rest of our break has been spent on a raft-house in the middle of the lake, swimming, zipping around the lake to various restaurants and the (usually submerged) Old Temple, and generally doing nothing. We've had a few issues after a big storm took out the power for 24 hours (lots of frantically packing vaccines into cool boxes and back again into the fridge) but otherwise it's been wonderfully relaxing. The new doctor, Sophie, has arrived, so once Violaine leaves next week it'll be the three of us (Sophie, Christian & me) from here to September.
Saturday, April 09, 2005
For all the worry-warts...
I know that I was out of contact for two weeks. I know that people are concerned about me and I know that this is because they care - I love this about my friends and family. But although I have access to internet in Sangkhla, it may well be a week between one access and the next. When I'm in the village, it might be two or three weeks where I am out of communication. This will happen perhaps every month once staff changes are stabilised. PLEASE do not see this as a sign that something has gone wrong - it's just a sign that most of the world lives without electricity, phones, and computers.
So, please don't fret. I will be in contact when I can. And thank-you muchly for caring about me.
So, please don't fret. I will be in contact when I can. And thank-you muchly for caring about me.
Thursday, April 07, 2005
The nitty-gritty
All the essentials, since everyone is asking:
The House
…is big. We have a verandah with fairy lights and sound system, a lounge with satellite TV (so I can watch the Pope being carried into the basilica), kitchen with the basics and washing machine, western toilets. I have a room with double bed, mosquito net (I am yet to lay eyes on a mosquito, but the number of people with malaria mean that they must be around!), two cane shelves, fan, clothes rail. We have a maid so I don’t have to wash any clothes or dishes. In short, we are quite spoilt.
The Climate
… is hot. At least mid 30s during the day and not much cooler at night. In the village, cool enough overnight to occasionally put a long-sleeved top on. It’s rained a few times, but is apparently only getting started.
The Food
… is also hot. We get fed everywhere we go – rice and at least 3 or 4 other dishes, eg tiny fish and mango curry, vegetables such as okra, beans, gourd and ferns, eggs, spinach, “bush pork”. Generally great food and lots of it. In Sangkhla, the food is so cheap and close by that we basically don’t cook, but go out to a guesthouse. I brought my Vegemite, establishing me as a true Australian in the eyes of my colleagues, and we can generally get bread for breakfast.
The Village
…is remote. We take over the raised bamboo house of the laboratory techs when we stay. Pluses: lovely people, interesting medicine, beautiful area, medics wanting to learn and me actually knowing enough to teach! Minuses: long 4WD trip (including at least 50 river crossings: there’s talk of hiring elephants for the rainy season!), lots of people with no access to necessary treatment, not so good when you’re sick and just want a soft mattress and TV!
The House
…is big. We have a verandah with fairy lights and sound system, a lounge with satellite TV (so I can watch the Pope being carried into the basilica), kitchen with the basics and washing machine, western toilets. I have a room with double bed, mosquito net (I am yet to lay eyes on a mosquito, but the number of people with malaria mean that they must be around!), two cane shelves, fan, clothes rail. We have a maid so I don’t have to wash any clothes or dishes. In short, we are quite spoilt.
The Climate
… is hot. At least mid 30s during the day and not much cooler at night. In the village, cool enough overnight to occasionally put a long-sleeved top on. It’s rained a few times, but is apparently only getting started.
The Food
… is also hot. We get fed everywhere we go – rice and at least 3 or 4 other dishes, eg tiny fish and mango curry, vegetables such as okra, beans, gourd and ferns, eggs, spinach, “bush pork”. Generally great food and lots of it. In Sangkhla, the food is so cheap and close by that we basically don’t cook, but go out to a guesthouse. I brought my Vegemite, establishing me as a true Australian in the eyes of my colleagues, and we can generally get bread for breakfast.
The Village
…is remote. We take over the raised bamboo house of the laboratory techs when we stay. Pluses: lovely people, interesting medicine, beautiful area, medics wanting to learn and me actually knowing enough to teach! Minuses: long 4WD trip (including at least 50 river crossings: there’s talk of hiring elephants for the rainy season!), lots of people with no access to necessary treatment, not so good when you’re sick and just want a soft mattress and TV!
Wednesday, April 06, 2005
From Bangkok to the jungle and back again...
I’ve spent most of the last 2 weeks living in a village in the middle of nowhere. No electricity, no cold drinks, no easy transport. We spent 4 days doing a nutrition survey – going house to house to ask about the food supply, and weighing all the kids under 5 years old. I’ve established that I am terrifying (I was hoping to just be a curiosity) and that I’m terribly clumsy (more on this later). We found 3 kids with severe malnutrition (in about 200) so it’s not good but not so bad. We haven’t analysed the rates of chronic malnutrition yet, but I’m getting used to four-year-olds the size of the two-year-olds I’m used to!
The other days I spent variously seeing patients out in the villages, in the IPD (inpatients department) of the village where we were staying, and sleeping off diarrhoea (thankfully only one morning!). I’ve learnt to “shower” by throwing dishes of cold water over myself (and how to tie a sarong so as to do this in public and stay decent – somewhat difficult when I’m not even supposed to show my shoulders!). I’ve discovered that Uno is a very good game to play when you do not share a language. I’ve learnt how to ask for eggs in Mon and intrigued the medics when I proceeded to decorate them for Easter.
So, after eleven days in the village, we did the 7 hours four-wheel-drive trip back and the next day, another 7 hours to Bangkok! Was quite surreal to be sitting in a 5-star hotel conference room for the Thailand MSF Annual General Meeting. Went a bit crazy stocking up on the luxuries not available in Sangkhla (Earl Grey Tea and Gin & Tonic) and even found an Indian restaurant.
So now am back in Sangkhla. We’ve have a few staffing changes amongst the expats and next week the new doctor will arrive, to replace V, who has to return to France. It’s Songkran festival for 3 days next week so the plan is to hire a houseboat on the lake and do very little. For the Thais and Mon people, it’s a time to spend with family and (as far as I can tell) throw water all over each other to welcome the rainy season. Am looking forward to a bit of a rest!
The other days I spent variously seeing patients out in the villages, in the IPD (inpatients department) of the village where we were staying, and sleeping off diarrhoea (thankfully only one morning!). I’ve learnt to “shower” by throwing dishes of cold water over myself (and how to tie a sarong so as to do this in public and stay decent – somewhat difficult when I’m not even supposed to show my shoulders!). I’ve discovered that Uno is a very good game to play when you do not share a language. I’ve learnt how to ask for eggs in Mon and intrigued the medics when I proceeded to decorate them for Easter.
So, after eleven days in the village, we did the 7 hours four-wheel-drive trip back and the next day, another 7 hours to Bangkok! Was quite surreal to be sitting in a 5-star hotel conference room for the Thailand MSF Annual General Meeting. Went a bit crazy stocking up on the luxuries not available in Sangkhla (Earl Grey Tea and Gin & Tonic) and even found an Indian restaurant.
So now am back in Sangkhla. We’ve have a few staffing changes amongst the expats and next week the new doctor will arrive, to replace V, who has to return to France. It’s Songkran festival for 3 days next week so the plan is to hire a houseboat on the lake and do very little. For the Thais and Mon people, it’s a time to spend with family and (as far as I can tell) throw water all over each other to welcome the rainy season. Am looking forward to a bit of a rest!
Sunday, March 20, 2005
Hello from Sangkhla!
Am now in Sangkhlaburi and have had a very difficult few days. They have basically consisted of - lazing round in deck chairs by the fan, under the fairy lights, as french reggae plays in the background
- a barbeque
- drinking beer
- getting invited to dinner by one of the local Mon staff, being fed lots of amzaing food and watching surreal japanese kid's ninja shows dubbed into Thai
- going swimming in the lake.
I can probably handle this lifestyle quite well!
Of course, this will not be usual. It was good timing for me to arrive on Friday night from Bangkok, so to have two days to relax and get to know the other expats here (Christian - field co-ordinator, Violande - doctor (yes, not just me!) & Jean-Baptiste or JB, lab technician). We will be doing a nutritional survey & immunisation campaign next week and I have heard a bit about the dramatic medical problems of some of the people here. Have been studying up on how to define acute vs chronic malnutrition and what to do about it!
Have found out a bit more about the area of Kanchanaburi: the river Kwae (Kwai) with its famous bridge is in Kanchanaburi itself, and we drove past Hellfire pass on the way here. Will try to visit these places properly one weekend.
One thing I have found unusual is the burning off - to promote new grass growth before the rainy season. As we drive around at night, whole hills are alight just next to the town, and echoes of bushfires spring up in my head. My french colleagues do not understand my reaction to this!
So, must go and do some more very little.
- a barbeque
- drinking beer
- getting invited to dinner by one of the local Mon staff, being fed lots of amzaing food and watching surreal japanese kid's ninja shows dubbed into Thai
- going swimming in the lake.
I can probably handle this lifestyle quite well!
Of course, this will not be usual. It was good timing for me to arrive on Friday night from Bangkok, so to have two days to relax and get to know the other expats here (Christian - field co-ordinator, Violande - doctor (yes, not just me!) & Jean-Baptiste or JB, lab technician). We will be doing a nutritional survey & immunisation campaign next week and I have heard a bit about the dramatic medical problems of some of the people here. Have been studying up on how to define acute vs chronic malnutrition and what to do about it!
Have found out a bit more about the area of Kanchanaburi: the river Kwae (Kwai) with its famous bridge is in Kanchanaburi itself, and we drove past Hellfire pass on the way here. Will try to visit these places properly one weekend.
One thing I have found unusual is the burning off - to promote new grass growth before the rainy season. As we drive around at night, whole hills are alight just next to the town, and echoes of bushfires spring up in my head. My french colleagues do not understand my reaction to this!
So, must go and do some more very little.
Tuesday, March 15, 2005
Monday, March 14, 2005
Starting out...
Change of plan - again.
Now not going to Paris but direct to Bangkok. Found this out on Friday morning. 15 minutes later my washing machine broke (halfway through a cycle). Thankfully my housemate was on hand to deal with me!
Moved this weekend so now have boxes distributed across Melbourne. I still know where everything is - should write that down, perhaps. Thanks indeed to Jen, Cathy, Barb, Trish, Roland, Dad, Mark and ESPECIALLY Derek for doing much beyond the call of duty and keeping me (mostly) sane.
So - am now in Sydney. Have 2 days to settle before truly heading away...
Now not going to Paris but direct to Bangkok. Found this out on Friday morning. 15 minutes later my washing machine broke (halfway through a cycle). Thankfully my housemate was on hand to deal with me!
Moved this weekend so now have boxes distributed across Melbourne. I still know where everything is - should write that down, perhaps. Thanks indeed to Jen, Cathy, Barb, Trish, Roland, Dad, Mark and ESPECIALLY Derek for doing much beyond the call of duty and keeping me (mostly) sane.
So - am now in Sydney. Have 2 days to settle before truly heading away...
Thursday, March 10, 2005
Change of plan...
Nothing like doing things last-minute!
Got a call this morning that I'll be going elsewhere in Thailand - still along the border, but further north, a place call Sangklaburi. It'll also be for 6 months rather than four. Don't know a great deal more at this stage - watch this space!
Got a call this morning that I'll be going elsewhere in Thailand - still along the border, but further north, a place call Sangklaburi. It'll also be for 6 months rather than four. Don't know a great deal more at this stage - watch this space!
Wednesday, March 02, 2005
Can't spell "eye-tin-er-ry"
So...
I leave Melbourne to go to Sydney on 14 March (Monday). Will meet up with my mother (Hi, Mum!) there.
Go to MSF office 11am Tuesday. Presumably don't do much more than pick up visa there as fly out of Sydney at 5pm.
Go via Singapore.
Get into Paris at 6:15am Wednesday. Day off to recover, freeze and see close mate living in London (thankfully she's coming to Paris).
2 days of briefing.
Fly out sometime that weekend (they organise this from there so have no idea yet) in order to be back in Bangkok by 20th (Sunday).
Whilst I love the concept of going to Paris first, not sure how my body will handle the jetlag and temperature zaps (March in Paris to March in Bangkok!). Tips for plane sleeping, anyone?
I leave Melbourne to go to Sydney on 14 March (Monday). Will meet up with my mother (Hi, Mum!) there.
Go to MSF office 11am Tuesday. Presumably don't do much more than pick up visa there as fly out of Sydney at 5pm.
Go via Singapore.
Get into Paris at 6:15am Wednesday. Day off to recover, freeze and see close mate living in London (thankfully she's coming to Paris).
2 days of briefing.
Fly out sometime that weekend (they organise this from there so have no idea yet) in order to be back in Bangkok by 20th (Sunday).
Whilst I love the concept of going to Paris first, not sure how my body will handle the jetlag and temperature zaps (March in Paris to March in Bangkok!). Tips for plane sleeping, anyone?
Cultural confusion
Had a great talk last night with a friend who has good reason to know what it's like to live in another vastly different culture. I realised that, although I've travelled before, it's always been in a situation where English/Aussies are the dominant cultures - if not in that country, then at least within the travel group. I've never been immersed in another culture without another Aussie around (well, perhaps for 3 days in Manila, and being by myself in London certainly doesn't count!).
I'll be in Thailand.
My patients will be Karen.
My colleagues will speak French (primarily).
I can't begin to comprehend the cultural issues. I'll have no-one to share vegemite with!
I'll be in Thailand.
My patients will be Karen.
My colleagues will speak French (primarily).
I can't begin to comprehend the cultural issues. I'll have no-one to share vegemite with!
Monday, February 28, 2005
Who?
The project is run by Medecins Sans Frontieres France, aka MSF or Doctors Without Borders. MSF has 5 centres in Europe that direct their projects worldwide. They run 4 projects in Thailand (the Belgian office also has one). For my project, there are two other expats - a field co-ordinator and a nurse / midwife - and about 20 local staff, some of whom have been trained as clinical staff.
The camp is home for about 9000 Karen ("Kuh-REN" for my fellow Aussies) people who fled from Myanmar around 1997 and were housed in this camp from June of that year. Their tribe is one of several around the border area that are minorities in both Thailand and Myanmar. In this camp, most of the people are Christian and few speak Thai.
So, am not just having to learn a bit of Thai, but Karen and French as well!
The camp is home for about 9000 Karen ("Kuh-REN" for my fellow Aussies) people who fled from Myanmar around 1997 and were housed in this camp from June of that year. Their tribe is one of several around the border area that are minorities in both Thailand and Myanmar. In this camp, most of the people are Christian and few speak Thai.
So, am not just having to learn a bit of Thai, but Karen and French as well!
When?
I'm heading off from home on the 14th of March and (as you do) going to Bangkok via Paris. Expect to be in Thailand by 20th of March for roughly 4 months, depending on how the project goes.
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