Derek with part of Large Gold Object, in Vientiane.

The Large Gold Object itself. This is a temple that has been covered in gold, so requires sunscreen to visit.  

The demons that protect the "Emerald Buddha". The Buddha has different gold outfits depending on the season, and there are signs in the viewing area to tell you not to point your feet at him. This is rather unclear - as is the Lonely Planet when it says the same thing - what part of your foot is the "point"? 

My hands. 20 minutes after the test where they blow up a blood pressure cuff and leave it on for a full five minutes, to see how purple you go. 

The surreal blue elephants at Trat airport. (Vientiane airport appeared to receive about the same number of flights, which is odd given that it's a national capital). 

And now, for a brief travel slide show. I'm being selective! This is the lovely pool at the resort at Koh Chang. I didn't actually get in it! 

Speaking of coming home...

I've officially applied to extend my placement here. And not hearing any horrified screams from Bangkok, that means that I'll plan to stay until early-mid December, do the debriefing in Paris, drop into London (that is, if my mates there aren't all sashaying on dancefloors in central America at the time) and hopefully be home for Christmas. Leaving enough time to find a house, visit the interstate rellies and reacclimatise before starting work again.

I really do miss you all. Lots. But I orginally left a year free, so I might as well use it. To be here for only six months would be a missed opportunity, especially when it's only the last month or so that I've felt like I might be getting the hang of things. And there's so much to do! I know that once I leave, there will be someone else to do it instead, but I'd like to follow through as much as possible.

So, thanks for your ongoing messages and support, and all going well I'll see you in 5 months!

Rainy days

The rainy season has been with us for a couple of months now. We do get some sunshine, but every day there's a steady rain and occasional ridiculous downpours.

This is fine, I like the rain. The lake has just started to fill, giving the false impression of floods as the banks, covered with grass and small shrubs in the last few months, slowly submerge.

I'm used to the bugs that get into everything (and will now cheerfully drink a cup of tea with several dead ants floating in it), but I can't quite get used to the mould. The house smells of it. My clothes have shadows of it. I went away for 3 days and came back to find my sandals covered in a velvety layer of green. Even my diary went mouldy!

If, when I return, I'm a bit whiffy and green around the edges, please be sensitive and forgive me!

Recommended reading part 2

I don't believe that I've ever read The Economist before. Its title is enough to put me off completely! However, I couldn't ignore the "How to Save Myanmar" splashed across the cover of the July 23 edition, and I was having a reading material frenzy anyway.

Of course, the article didn't quite offer the solution it proclaimed. But it did have a good overview of the current situation in Burma - one which I'm starting to get the hang of, if that is at all possible. To quote, "It cheerfully exports drugs, refugees and disease to its neighbours and beyond." Since this edition, the situation has been complicated further by the sentencing of the deposed head-of-intelligence-forces Khin Nyunt to 44 years in house arrest for "corruption".

Prior to coming here, I knew of Aung San Suu Kyi (but not how to pronounce her name - go on, give it a go!) and had heard of SLORC, the military junta - now jauntily renamed the State Peace and Development Council. There's so many convolutions it makes South American politics look simple. So for anyone who might be trying to keep up (and I know that's perhaps two people reading this, but still), grab a copy of the magazine!

Pig-headedness (with no relation to previous pig)

It may have been my frustration with taxi drivers.

It may have been my independent streak.

It may have been wanting to move after 3 hours in the bus.

But really, it wasn't. Some of you may know my pig-headed side. Stubbornness, along with clumsiness, runs in the family. And while being clumsy gives you great reflexes, I'm yet to see the benefit of stubbornness.

So when I got to Kanchanaburi and was faced with "Hello, Miss!", "Taxi, Miss?", "Where you go?"... I cracked. I had been told it was a ten-minute walk. So instead of paying one australian dollar for a tuk-tuk, I shouldered my 17ish kilo backpack, chockablock with peanut butter, tonic water and tinned apricots, hoisted my 4 shopping bags and wooden elephant puppet, and, ignoring the 35 degree heat and blisters on my feet, started to walk.

The ridiculousness of this became apparent after about 7 metres.

However, I had started to walk, and so walk I bloody well did.

At least it wasn't raining.

One thing I didn't expect

Today, I saw a man who had been attacked by a jungle pig.

Admittedly, he had shot it first.

Moral of the story is: shoot straight. Or leave it be. And make sure you've had your tetanus shots!

Hmong refugees

In response to a comment (note: not a post) on MaccaMusings, I'd like to offer this article as illustration of what happens when a country treats people as "illegal" before treating them as people. 6000 people are living on the side of the road, without sanitation, in rainy season. Some of my friends are now providing some assistance.

Leaving...

Derek hopped on the bus, and within 24 hours is half a world away again.

Despite a lovely 2 weeks, it's rather crap being the person left behind. Which I know is usually not me. But I'm moping a little.

Back from travels

Yes, I spent three days in Laos and loved it. To have a capital on the banks of the Mekong, where there is more bicycles than cars, lots of temples, bread and fresh beer, where the airport has two gates that are set at a height twice that of the planes that arrive and it set only 10 minutes by tuk-tuk from the city centre, where your gold-covered national religous icon and major tourist attraction only has 3 people looking at it, seems a lovely way to live.

And then we flew back to Bangkok.

Geography quiz

So, since I didn't get that visa before, am now in another country for a couple of days.

A crusty baguette to whoever can tell me the capital and currency of Laos without cheating.

Not you, Kel, sorry. But love this city!

D is for Dengue

Hello, all. Please forgive my absence.

The plan was to spend last week lazing on the beach with Derek, perhaps do some snorkeling, and eat a lot of seafood.

The day he arrived in Bangkok, I was in hospital in Maesot. I had spent a rather unpleasant 24 hours vomiting, and the fever had me worried. They did some tests, told me it was a virus, gave me antibiotics anyway and sent me home.

I basically slept for the next five days - some of it in a lovely bungalow at the beach. Then I stopped sleeping as my hands and feet developed the most intense, unresolvable itch. When I woke up with petechiae (tiny red dots indicating bleeding into the skin) all over my feet, I figured it was time to go back to the doctor.

The test for dengue involves inflating a blood pressure cuff on your arm and then leaving it for 5 minutes. This HURTS. And, just as expected, my arm was a glorious purple afterwards.

I went and slept some more. The next day I got some slightly scary blood results and they did the same test to the other arm. I slept.

So, the holiday didn't quite go according to plan. But two of my colleagues ended up in hospital in Bangkok for several days - something I managed to avoid through the cunning plan of going to the beach anyway. And I'm fine now - just waiting for the tourniquet marks to fade. Wouldn't recommend Dengue to anyone, though - another reason to pack the repellant if you're planning on coming to Thailand.

"If there's pus about, let it out."

Abscesses are most revolting, yet most satistfying.

Enough said.

Thank-you, Mr Pratchett

I've been listening to a novel where one of the central characters is a Tourist. That is, he arrives in the city for the sole purpose of Looking At It, he has a book that tells him how to talk and he has no concept that is money is worth as much as people's houses.

His reluctant tour guide learns some new words from this man.

Picturesque means "highly precipitous".

Quaint means "tumbledown and fever-ridden".

This book has given me some giggles whilst driving between our clinics.

But if you or I had a palm-leaf roof to withstand monsoonal rains in an area where malaria, dengue and cholera are endemic, we'd all live in Quaint villages too.

Albino fish in a pot at the house.  

The lotus flowers at Jim Thompson's House. He collected ancient Thai treasures, rejuvenated the silk industry and in 1967 went for a walk in Malaysia and hasn't been seen since. 

And now for another virtual tour, this time of my weekend in Bangkok. This picture sums it up - highrises, construction, a temple and a slum. 

Ahh...

After an intense few days, we can relax a little. We had pasta. With real pasta sauce. And bacon. And Australian red wine.

And the three French people currently in my house commented that the French wine industry is in trouble.

Ahh.

Chilling out

Geckoes are odd creatures. There's the little house lizard ones, which look rather amphibian. And there the huge ones with bright red and blue knobbles, which are loud enough to wake you up and in Thailand are called "Tokays". There's a whole nother story about me being secretly shocked that otherwise normal French people keep turkeys in the house.

A couple of days ago I met a tiny baby amphibian-like one in the kitchen. It was obviously terrified at the sight of me, and ran to the nearest dark hiding place.

Unfortunately this was the fridge I just opened.

Now, it hid quite effectively in behind the crisper drawer. The problem, if you happen to be a tiny amphibian-like creature, is that a refridgerator is not a place to spend much time. Its initially zippy running style slowed in the space of about 20 seconds to a sleepy plod, and then stopped.

By this time I had removed the crisper drawer and most of the fridge contents (eek). This baby lizard managed to slowly manouvre a eye around to look at the huge lumbering thing about to kill it as it froze to death.

I poked it. It fell upside down in a foetal curl and lay, still staring at me with one eye.

What else could I do?

I put in on the floor, got down on hands and knees and resuscitated it.

Thankfully this only involved a few (one-two-three-four-five rescue) breaths in its general direction and it perked up enough to stand up. Two more and it could lift its head, another and it scuttled away from this odd giant breathing on it. I closed the fridge to prevent a replay.

Even more thankfully, none of my colleagues chose that moment to walk into the kitchen.

An experience of one minute, yet a most satisfying result.

The gecko in the toaster did not do so well.

You know you're in Asia when...

they sell live fish in the supermarket.

How not to get a visa extension

I wore: long sleeved shirt, foundation for the first time in months, earrings and my most polite professional smile.

She wore: camo jacket, black leggings, bleached blonde hair, plastic straw through her left earlobe, at least 10 other (visible) piercings and the faintest whiff of dope.

I said: Sawasdee kaa. I'd like to apply for a visa extension.

She said: Visa - how much?

I got thirty days (I was hoping for 90).

She got advised to go to Cambodia.

Kanchanaburi

Our nearest city, our nearest spot to relax for the weekend, an important historical site and our nearest source of cheese, gin and proper chocolate. We made the trip to Kanchana about a months ago now... here's some of the photos.

The city was known as Camburi to my grandfather when he went through here to further up the railway. It's the official Aussie memorial centre and the cemetery is beautifully kept, with rows and rows of headstones of Australian, British and Dutch troops. I've never been interested in war history, but now I'm in the same spot as my Grandfather was 63 years ago, and beginning to read some of the personal experiences of the prisoners along the railway, its meaning is very different.

The spectacular street lamps in part of Kanchanaburi. Fish seem to be a recurring theme, as I'll try to show you later. 

Water lilies around our hotel room - a raft house on the river. 

You may not able to read the fine print. It says, "Yokogawa Bridge Works, Tokyo, Japan." 

The Famous Bridge on the River Kwai. Or at least the latest reconstruction of the Famous Bridge on the River Kwai. With a monsoonal thunderstorm coming in, I didn't spend too long on it, for fear of lightning strikes, and anyway no matter how Famous it may be I'm not that into bridges. 

ANZAC graves extending into the distance. 

View from the memorial pavillion in Kanchanaburi cemetery - the flame tree overhanging a pillar from the adjacent Chinese cemetery.

Oh, joy!

There is an ice-cream parlour in Sangkhla!!!

Tucked away in the concrete shops, behind a big pile of dirt, there is a real true ice-cream shop, with a gaudy menu, tall glasses, chocolate sauce and cherries. I just had a cappucino parfait!

To think it took me 3 months to discover this.

Support

Thanks to everyone who has responded to my post about the little girl. Your support is amazing, and has helped me deal with it a bit more. I didn't want to cause so many tears, but she deserves them, even from those thousands of kilometres away.

Hypocrisy

I'm all for being treated equally. I don't want any special privileges just because I happen to be female, white, and a doctor.

But I really do like being allowed to sit inside the car for a 7 hour four-wheel drive trip.

Early morning sun over one of our clinics. 

Some of the eleven people involved in fixing my toe after the nail tore off! I'll spare you the close-up.  

Our office (the house is behind).

Our lovely verandah. 

A typical inpatients department. 

Two colleagues and the bamboo that could take over the world! (At the national park we visited today - gorgeous waterfall for swimming!). 

Hellfire pass - the memorial plaque, at 6:30am. Notice the Thai journalist taking a photo from the other end! 

The old temple in Sangkhla- submerged for most of the year. 

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!

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.

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!

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.

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!

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.

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.

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!

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!

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.

Lovely pics

Here's some gorgeous pictures from Sangklaburi. Thanks Dad for the link!

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...

Here 'tis.

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!

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?

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!