The Dutch phenomenon, and other musings

Time for the weekly missive...

Work

Work's not bad. Did a week-long intensive block of medic training last week - for the medical nerds amongst you, I taught a full day of skin/hair/nails (by the end of which everyone in the room felt itchy) and a day of heart stuff and heart failure. It's actually really fun teaching the medics - relaxed and interactive. They did well in my exam questions too so it's nice to see that some of the information sticks!















I spent one day out with community health workers doing home visits. Along the way I happened to see a baby (strapped to its mother like all good Karenni babies) who looked like perhaps it wasn't doing all the things it was supposed to do. Probed a bit further - turns out the baby (who is 1 year old now) had a severe bout of something septic when it was one month old. Seems that the doctors in town didn't think to tell the mother of the permanent neurological sequelae and she has been dutifully (and beautifully) - and completely independently - been caring for a baby with severe spastic quadriplegic cerebral palsy for the last 11 months. I know that a lot of the differences in medical care and communication in Asia are down to cultural differences, but this one I just cannot fathom. Surely cultural differences are not enough to obviate the need to give parents this type of news?

We (well, me and Komsak, who is now the lynchpin of the clinical health team) can feel a new disability clinic coming on.

The office is - well, it's the office. I haven't been spending much time in it, which is not a bad thing at all. Trying to let the political arrows fly around me is a difficult thing ("What?", you say? "Q finding it difficult to keep her mouth shut? Never!") but disengaging is a fine art that I need to learn. Preferably around now.

Goodbyes
After a week of dancing, eating, laughter and friends, Marlene (ace boss) left last Wednesday.

Marvellous Marlene and medics from camp

We (clinical health team, friends, "adopted family") were all desperately sorry to see her go - the refugees felt it perhaps even more acutely than they did. I hope there are consequences (however karmic) to large organisations in not heeding the requests of the refugees and placing faith in their knowledge of what is best for them.

Stir-crazy

The last week has been good but I'm still itching to get out of town - so Chiang Mai, here I come! I can't wait to see my CM mates, walk down the street without seeing people from work, go out to hilarious clubs (where I can drink something "on the rock"), go shopping, eat whatever I food I want at any time of day or night, hit the night markets, hang out for a few beers... Is two trips in the space of 2 1/2 weeks gratuitous? I think it's just about right, really!

Random musings

I live out the back of a hotel/resort place (see pics of my little bungalow on a lotus pond) and yesterday I braved the resort pool for the first time. I am not exaggerating when I say that there was me, and then there were 30 or 40 Dutch people. That was it. I imagine they must be travelling in a big tour group but I confess it was kind of intimidating. I felt distinctly...not Dutch.









Home, sweet home

It got me thinking about the Dutch tourist thing. I don't think I've ever been somewhere overseas where I haven't met Dutch tourists, generally in groups. The population of the Netherlands isn't that big...so does that mean that about half of its population is travelling at any one time? Or that there is just a core of very very hardcore Dutch travellers? If the latter is true, surely some of the people I'm meeting are people I've met before?

I actually met (as in had a conversation with) a Dutch guy last night. I was sitting in one of the little pavilions over the lake, watching Wat Jong Khum (temple - see pics) all lit up for the start of Buddhist Lent. It was an interesting conversation (only one point of conjecture, which was to do with whether Muslim men in Holland should be expected to shake hands with women in a show of assimilation - I thought not, he thought yes) but the real point of interest was the temple itself - just beautiful!

Wat Jong Khum, lit up for the beginning of Buddhist Lent

There have been several times on this trip when I have wished that I were Buddhist. Sounds kind of simplistic, I know, but true. Last night was another one of those times, as I sat there and watched all the monks and townspeople walking around the perimeter of the temple with their candles and offerings. Of course, the full moon only added to the atmosphere...

Does the dust really settle?

It's been a while since I last posted, I know. I bet heaps of people have stopped checking for new posts just because they don't appear - that's okay.

Town life


I've been in MHS for nearly 3 weeks now. It's lovely - mountains and lush greenery, pretty lake and friendly people. Having said that, the small town thing has started to wear a bit. I guess when there are fewer than 8000 people in a town, it's to be expected that walking down the street, I run into people I know all the time. Everybody is somehow connected to someone who knows somebody who used to have lunch with another person whose daughter is the wife of someone from work. Fortunately since my last post I've moved out of the revolting place where I was being accommodated by my employer, and into a snug little bungalow on a lotus pond further from town. To be sure, it's part of the largest hotel/resort in MHS, but it's actually pretty secluded and gives me a definite sense of being not at work. Which, given recent events (as well as the hours I've been putting in), is definitely a positive.

People

There is a certain phenomenon amongst travellers that I have come to really despise - the expat pack mentality. What is it about being in a foreign country that automatically means that you are BESTBESTFRIENDS with people you would never have had a 3 line conversation with back home, makes people eat together every day and have the same conversations over and over again, makes it a kind of social default that deadens the brain and numbs the senses? What is it that makes it okay - even funny, sometimes - that a person can have lived or stayed in a country for months and yet be unable to order food in the local language?

Needless to say, I am not a fan.

It isn't all doom and gloom though. I have made a handful of friends who I think are fabulous people, people that I would be friends with back home. They make discovering a new place more of a joy and provide endless stimulating conversations. After the amazingness of my time and my friends in Chiang Mai I wondered if I would meet other like-minded people here. I think I will.

Camp

I got my camp pass about a week and a half ago and have already started training medics and midwives there. The camp looks more or less like a massive hilltribe village, but more cramped and a lot larger (19,000-ish people). Amazing concentration of beautiful babies and children, colours and life and laughter and a general feel of getting on with things. The men play real sport in the camp too - proper, athletic, boisterous sport, not this somewhat affected, don't-mess-up-my hair sport that Thai boys have a tendency to play. That is a generalisation, yes - but not an entirely unfounded one!


















Anyway, I got good feedback from my first teaching sessions so hopefully that augurs well for the next 5 months of teaching and training. Even from the limited chances I've had so far to really have a detailed look into the way things go, there's clearly a lot of work to be done on health. I hope I'll be able to get a few things moving and help out.

Desk life is not for me, and some restrained reflections

I've been chained to my desk for the last 4 days. There has been an unexpected - and very unwelcome - shakeup in my team here and suddenly, without notice, we are picking up the pieces after a badly handled situation arose. I'm trying to get the stuff together to do extra trainings next week, and also trying to organise myself to pick up some new and unexpected responsibilities. I guess this was what they meant by telling us we needed to be "flexible". Well, for me and my remaining team members at the moment, "flexible" kind of just means "more work". Oh well.

My team colleagues are fabulous, clever people - perfect examples of great capacity building. It's just a pity that it turns out that internal politics are far more of a problem than cross-border politics where I work, and that amazing success stories such as my talented workmates seem rare. I have some pretty strong views about this, but I won't unleash the diatribe here. Suffice it to say that I am trying valiantly to remember that it is the people in the camp that we are really working for. Organisations are a means by which to get to them. This is all stuff that I knew before coming here, but having it laid bare "in real life" is somewhat different. Potentially pretty disillusioning, but I think trying to stay focused will make it seem less important.

Anyway, I have a new admiration for those out there who work in an office every day. I am going so stir-crazy that I think I might explode. I'm in a bit of a surly mood today and this post probably reflects that. It has been a frustrating and difficult week; as of next week I'll be in the camp most of the time, though, so I think that will be a good thing. And a good few hours of sitting alone by the lake with a good book will definitely help. Thank goodness for the weekend!

Getting used to being useful again

I've been here a week now and fortunately it didn't take too long to find things to do. Without a camp pass I can't do anything hands-on (frustrating but hopefully very temporary) but I've been writing neonatal management guidelines for the training I'll do later on, talking to reproductive health about what I should be training the midwives to do, and I'm now waiting for community health to tell me what exactly it is that they do so that I can add stuff. Hopefully I'll have a temporary camp pass by Tuesday. People tell me not to hold my breath though. Blah.

My desk at work - I share an office with about 15 others

Other than that, I have been getting to know MHS - not too hard as it's not very big! My digs are not exactly salubrious (in fact, they kind of suck) so I've just started looking for something more permanent. It'll be a relief when all the practical stuff is done and I can just get on with things work-wise.

Dried fishy delicacies at the Sunday Market

In terms of social life - there are lots of Thais, lots of Burmese, lots of hilltribe people and LOADS of expats working here. I'm trying not to fall into the expat pack mentality which pervades most places - in the long run it is just frustrating and creates barriers to getting to know local people and customs properly. It's a delicate balance - I'll have to see how it goes. One thing is for certain though - I have to be really strict about practising my Thai as I already feel that it's slipping a bit.

Marlene, me, Naomi, Inbal

We (ace boss, ace reproductive health boss, ace new friend) went karaoke-ing on Friday night. The bar was outstandingly 80s. It looked like something from an early Tom Cruise movie, complete with veneered bar, chrome fittings and red disco ball. We had a Thai vs English (language) karaoke-off with 3 locals who were there - it was just us and them. I'm thinking that my rendition of "Have I told you lately that I love you" probably didn't help our cause, although "Love is all around" complete with backing vocals and whoas may have redeemed us a bit.

80s extraordinaire tacky karaoke bar (rivals on right hand side)

The week ahead, with luck, will involve me starting to train people in the camps, finding permanent accommodation, and getting generally set up. I'll keep you posted.

The next new start

I spent Saturday on Doi Pui (nearby mountain) near a Hmong hilltribe, planting trees with Jenny’s workmates and a few of our mates. It was pretty big – about 10,000 seedlings and scores of journalists. Picturesque setting too – high up on a mountain ridge with mountains and forest all around. It probably would have been even better had we not all gone out the night before and finished up with massive greasy burgers (my first in months) at 1am. The subsequent 7:30am start was character-building. Right?

Fish in the pond/pool thing at Warm Up (bar); Zach and Jen

"Kraff" of wine, anyone? Or perhaps something "on the rock"?


Me and Leah; Zach's enormous "cheesy mushroom double burger", consumed at 1am

Anyway, after the tree-planting I stayed at Benchawan’s, met her husband and two terrific sons, ate loads of food and gossiped. The next morning they dropped me at the airport, and thus ended my blissful 5 weeks in Chiang Mai.

The view from our tree-planting site was really not bad

So here I am in Mae Hong Son, where it is sunny and pouring with rain in equal measures. It’s a lovely little place – I live about 100 metres from the lake, which is a pretty tranquil spot with a beautiful temple overlooking it. There are thickly forested mountains around the perimeter of town, and in the mornings the mist weaves its way between the peaks, the lake and temple sort of glimmer, and it’s all a bit magical, really. The town itself has just under 8000 people, so it’s not exactly your buzzing metropolis, but there’s a bit going on. Everything is within walking distance and I have found the essentials – food places, roti trolleys, soy milk vendors and market – already.

Yesterday I started work and it was all a bit of a boggle! In the morning Aor, who is the new pharmacy supervisor, and I were introduced to about 50 people (it’s a very crowded headquarters!) in about oh, 20 minutes. The staff are a mix of Thai, Burmese, Karenni/Karen and expats. They’re very keen on three letter acronyms – GBV, VCT, LAC, something something something. Most of the jobs have the sort of titles that make you say, “Oh right!” but then 3 seconds later think, “…but what does that MEAN?”. I’m sure there is a system to it all, though.

Anyway I had a lengthy meeting with my boss, Marlene, and the other doctor who works there (who is Burmese) and we nutted out some more details of what has been going on and what Marlene is hoping I’ll be able to do while I’m here.

The real details are very different from the extremely vague job description that has been bandied around for the last 6 months, and is sooooooo much better! My title is “medical trainer” and to that end I will certainly be doing some block training for a new crop of refugee medics coming up. The exciting part, however, is that Marlene would like my main project to be to devise a system of integrated assessment and management of paediatric patients, from birth onwards. It’s quite a task – we administer the health care for 2 camps, one of which has 19,000 refugees and the other nearly 4000. There are 2 main clinics in the larger camp and one in the smaller one; reproductive health is currently entirely separate (and as such the babies who are unwell at birth do not come to the attention of our doctors and medics until much later, if they are transferred to town); there is no organised liaison with the paediatric services in town; and community health, which does a lot of the public health, case finding and surveillance, is sort of…well, apparently it’s hard to know WHAT they’re doing!

So this looks like being my job. I am so stoked with it – I never thought it would turn into something so tailored to my interest. I’m hoping it’ll be the perfect combination of paeds, refugee health and public health. But we’ll see – there is plenty of politics to contend with by the sounds of things, and I haven’t even started yet!

(Well, I started writing congenital heart disease and neonatal jaundice guidelines today. But that’s barely a start – plus I am still waiting for my camp pass.)

Anyway, so I emailed uni about all of this and they reckon I should write a 15,000 word project for 4 subjects’ worth of credit. Bonus!