the view from my traditional Thai coffee vendor

waiting out the rain

different generations

just me and the ladies...hollar

the first private clinic in Nang Rong

life and death

Yesterday: Maen is not his real name and he is open with his HIV status

During the day, nothing exciting happened but in the evening I had set up an appointment to meet with a man who I met at the hospital who was HIV +, Maen. I hopped on my motorbike around 4:30 and drove through rice fields and villages for about 40 minutes until I finally got to his village. When I pulled up he was totally surprised that (one) I actually came and (two) I was able to find him by myself. I had apparently proved myself to him, his father and his friends about how gaeng (great) I was by finding my way there by myself since it came up at least 8-10 times.

He had just gotten back from harvesting cassava. He was there all day in the hot sun working and gets paid 160 baht for the whole day of work: the equivalent of 5 dollars. He was okay with it because his family can eat for about 40 baht a day…however, I went with him to the house that sells a few groceries to help with dinner and the pork he was going buy was 60 baht for a ½ kilo which we ate all of that night, not including rice, vegetables etc. And had I not gone in the store and forced to pay for the pork he would of paid for everything. I am continually amazed with their generosity here and strive to cultivate my own.

Maen works as a labor hire (ropp jaeng) because he had to sell his rice fields when he was sick with HIV to cover the costs. I interviewed him for about an hour but only after I had to do the accustomed get to know you conversation with the young men drinking across the street: where you come from, are you married, do you like thai woman, can you drink rice whisky- USA, no, they are pretty, I can but only a little. This is then followed by taking a half-shot of probably my least favorite liquor in the world maybe only topped by bai-jiu (Chinese rice whisky).

Maen got HIV from his first girlfriend and the only other person he has slept besides his wife who is also HIV+. He has been HIV+ for 10 years and he is my age. However, he looks much older than me until he smiles and you can see the youth that is still there. He has a strong sense of responsibility for his family, which was evident the whole evening and the next morning that I was there…and the reason that I think he is still alive.

His father and mother and wife all live there as well as his older sister and two nieces. His two nieces clearly look up to him as a father figure. I think that the girls’ actual father was there too but if it was the one who I thought it was he was drunk early and gone late.

After interviewing Maen and his wife, he drove me to another person in the village who is HIV+. The man and his wife just had a three month old child and they were feeding her bottled milk when I we got there. It turned out the two of them had just recently gone to a conference, with a current PCV for strengthening PHA groups. The conference was part of the program I helped start and was a consultant for with Peace Corps. It was special to see the reach of it and its continuation. He of course, called the PCV and we had a nice but sort of awkward conversation since we don’t really know each other.

We left promptly before 7pm so that Maen could take his ARVs on time. He is on the third level of drugs in Thailand. The fourth level of medication is expensive and is not currently covered under the universal health policy. His wife has not had to take drugs yet and her CD4 count is around 400 still after being HIV+ for 8 years (typically in Thailand they start patients on ARVs when there CD4 count is 250 or below).

The village they live in his very poor, with the streets torn up and long distance to the main road. Their house was your typical old village style house, on stilts, made out of wood and tin roof; however, it was very comfortable inside. Dinner was nice (Eating is always more enjoyable with other people, especially in Thailand). After dinner, we watched a little TV and I help the niece do some of her homework before we went to visit a next-door neighbor who had just gotten back from the hospital.

Maen, his mom, his wife, the two nieces and I, walked down the street around 8pm with a crystal clear Issan sky. You can tell you are on a plateau when it is a clear night and you can see the infinite openness of the sky and the stars. We walked in the dark for about 5 minutes to the neighbor’s house. It was also a traditional house and I could tell by the numerous flip-flops surrounding the ladder to the porch that nearly the whole village was visiting it her.

I will never forget the scene in the house. The woman was lying down with a blanket over her bottom half. She was lying there only occasionally moving, clearly suffering. Her husband was sitting next to her on the left hand side. A friend or relative who was missing her two front teeth was massaging her right arm which incredibly swollen. The woman would close her eyes but could not sleep. There was about 30 people or more sitting around her. The house was completely full with relatives and friends. She had just gotten back from a hospital in Khorat where she was getting treatment for cancer for the last two months. Apparently, the doctors could not do anything else and she was brought home to be taken care of by her family for the last weeks of life.

The atmosphere was so beautiful and so sad at the same time. People would take turns massaging her one on either side. Her husband didn’t say anything and just sat next to door on the wall. People’s conversation would move from talking about her, cancer, health, and for a while about me (the random white guy who speaks their language and amazingly made it the village by himself). It was such an intimate situation and I was nervous about going in initially but people were sweet and welcoming and seemed to enjoy a temporary distraction.

Shortly after we got their Maen began massaging the woman, helping her lift up her legs which she wanted to do about every 20 minutes or so. Earlier Maen had described to me how sick he was before he started ARV treatment and how he felt like he was going to die. He talked about how he could barely lift up his body. I saw him in the same position as the woman, not able to sleep, not able to walk, not able to eat. And now there he is healthy and strong and compassionately massaging the woman knowing what feels like to be in that position.
After we had been there for awhile and the kids started to get restless they asked to see the pictures I had taken of them playing badminton. I began showing them the picture of them playing and they ask to see pictures of my girlfriend and pictures of the US and snow. So I started showing them pictures and movies of us playing in the snow. It was very surreal to feel like I was in both places at once, in the mountains in Seattle with my friends and sitting on a wood floor next to a woman who was suffering from the last stages of cancer in a village in Issan.

One person, next to me talked about how we should not believe all of what the doctors say. He said, they know about medications and drugs but not everything. Which speaks to one the respect of villagers towards doctors in listening to what they say but also a bigger spiritual picture of health and that doctor’s and western medicine is just a part of the picture.

In Peace Corps and yesterday I am struck by the feeling of the closeness of illness and death but also by the openness of it here. In the States, I have never massaged someone dying of a cancer or poured water as blessing on the recent corpse.

We left the house around 9:30pm and sat outside on the hammocks at Maen’s house talking about cancer, death and how amazing it was that I was able to find the village and Maen’s house by myself.

Around 10:30pm I fell asleep and was awoken around 1am by two of the guys who were drinking earlier and a third guy. They were rehashing the evening quite loudly in the room that I was sleeping in. I was trying to act like I was still sleeping so that hopefully they would stop talking but that didn’t happen. So eventually, I rolled over and said hi and they told me how they had lost 3,000 baht gambling ($100). They were talking about how they would try to get the money back and what they would need to do. I am assuming that they didn’t want to tell their wives/family. Finally, they went to sleep and then I fell back asleep until 4:30am when the temple started blasting traditional Thai music out of their loud speaker.


Normally, I love traditional thai music and the ranad-ek, a wooden xylophone. But the constant loud patterning and than the wailing thai bag pipe instrument that begins muay thai fights is just not pleasant at 4:30am and impossible to sleep through.

So I woke up and saw the stars again, waited for sunrise, went to the temple for Wan Phraa before hopping on my motorcycle and heading back to Nang Rong today.

My project is in full swing and I have been interviewing people in their villages...it has both been tiresome, wonderful, boring, exciting, enlightening.

A normal day involves networking with people in the province town, preparing for interviews. Motorbiking 45 minutes or more through rice fields to meet some villagers. Sometimes the interviews work great other times not so much. I have interviewed around 25-30 people so far but didn't record all of them and not going to use all of them so want to get more indepth deeper interviews.

Health is a different concept here and it is tricky to figure how to ask about it especially when my target audience doesn't think much about it. Also, everyone is in the field planting rice so I have about 2 hrs a day when I can meet with people 5-7pm so I get a lot of riding in twilight. It is super beautiful here and people are being so kind and wonderful. Here are some pics from the last few days:

riding back from interviews

the snake I ate when I was introducing myself to the village leader

my research assistant

the temple from one of the villages

a traditional healer and his buffalo: traditional medicine is still used, often combined with modern treatment

More later,
Hugs, N

Back in Ubon

Yesterday was super beautiful. I woke up in the large living room with my Thai family all sleeping around me, Paw Som Boon, Maa Jittawe, their grand kids and my little brothers luk ger and neung niu.

Neung Neo and I in the car

There is something different about waking up here, there is something in the actions and rituals. Pi toe always gets up and starts steaming rice, while Maa is always in the garden, and paw is wearing his rubber boots going to their rubber tree plantation. The kids are covered in powder after their shower and I just sit and watch on the bamboo sala as the observer. I am the guest, the weird foreign son who now has a beard and has been agreed upon that he should shave so as to not scare little kids away and look like a robber.

This morning neung niu is going to school; luk ger isn’t because of ‘Kai Wan 2009’ (H1N1). We all sit on the bamboo table and share breakfast. I ate on this table with them for 2 years nearly every meal. I missed the flavors, the chatting, sitting cross-legged, their sticky rice, and the pets that are around. Right now there are three dogs and one duck. My family has gone through 6 dogs since I first came here, a dog a year. It’s not that they don’t take good care of them but they let them just run loose and snakes and cars have been the main killer.

Luk Ger and I in the ricefields trying to find my friend

This morning Maa and Pi Toe take me to pay respect to an 84-year-old monk who lives by himself in a temple. The temple is beautiful but small and covered with donations, the typical orange buckets filled with toiletries, drinks, instant noodles, and candles, blankets, weaved pillows, strings for blessings, and fruit all being overlooked by the Buddha and the beautiful Bodhi mural on the wall. He is very interested in why I am there and I listen has they talk to about me for about 5 minutes before moving on. I don’t need to say anything because it is easier for Maa and Pi Toe to talk for me plus they know everything about me, it is a good feeling.

After that I had luk ger take me over to his great grandmothers house. She now sits on a sala in the front yard. She used to sit in a sala in the backyard but it is too hot there now. She also can watch the rode from her new seat and see who comes and goes. She can’t really walk anymore; she is the same as age as the monk. I pay respect to her has she smiles and barks Isan at me, I have always had a hard time understanding her but not listening to Isan for over a year and half makes it even tougher. I concentrate and understand that she is asking about my mom and dad, if I am married, talking about why she moved to the front and that she is getting older and her mouth hurts and she can’t really walk. She is old, but still very much with it. Sitting, watching, knowing more what is going on than the people who are actually doing the going on.

For lunch, we (Pi Dtung, Pi Noot, Pi Ba, Luk Ger, Neung Niu, Neung Neo) go to Had Ku Dua, my favorite place in Ubon. It is floating bamboo rafts on the Mun River, which is incredibly high this time of year. We have lunch for 4 hours and neung niu, luk ger and I go for a swim. I am able to treat everyone to lunch. It is a nice feeling.

In the River with Neung Niu and Luk Ger

In the evening, I biked to my old house that I stayed in for Peace Corps and here the common yells of ‘ahh, Noo-aw.’ Besides seeing my neighbors, the best thing is seeing the climbing yellow flowers that I planted on the dead tree in the front yard. When I planted it was so small and barely started climbing the tree. Now you can’t even see the dead tree it is covered in flowers and green leaves and the neighbors say they often talk about me and the tree. It is a nice feeling.

Neung Neo and Pi Toe (my Thai Sister)

The most common things I get asked are when did you come back? Are you married? Why not? How are your mom and dad and why do you have a beard? Normally in that order, and by at least 20 people (not kidding). It is sort of a nice feeling.

I then go over and see Neung Faa and Pi Dtao. Pi Dtao is HIV positive but her daughter Neung Faa is not. They both give me huge hugs, which are rare in Thailand, since normally affection is shown threw food. Pi Dtao elaborates to me about how great her job is in Bangkok (making about $200 a month) but is mixed because she has to leave Neung Faa by herself. However, the job pays for Neung Faa’s schooling and with some other help from friends we make it work. Pi Dtao also tells me how much healthier her she is and you can totally see it. The doctor’s told her the other day that they could barely detect the virus in her blood. She has been HIV+ for over 12 years. It is a nice feeling.

I can’t describe the feeling of being back. It is so beautiful and so wonderful to be reminded of normal life. It also feels good to see and feel that the time that I remember still exists and that I am still a part of it, just as much as it is a part of me.

The village street in the morning

Back in Thailand!

So after a little more than a year hiatus I have returned to Thailand. This time has an academic (or something like that...)

It has taken me a little while longer than I expected to get accustomed to the warm weather, speaking Thai and being a farang again. Probably, a combination of shedding off the stress from a crazy last year, time adjustment, and culture.

sunrise in Buriram

I have a great place to stay in Bangkok thanks to my friend Barry but from now on the majority of my time will be in Nang Rong, Buriram. It took me awhile to leave the comforts of Bangkok but I was really happy to get in the field and in the Northeast. My first cruise on my motorbike to a smaller village through the ricefields, my heart warmed up and I got flooded by emotions and love.

The people are so nice and open and should be conducive to interviews and work. I also have a great place to stay! It took awhile to find but patience is a virtual.

house that used to be a restaurant nice porch tables outside too

Dear Friends,
It has been a long time since I have written and I don't have much time right now since I am supposed to be finishing up a paper but very briefly wanted to give everyone an update not any deep insights.

It has been just over a year since I have been back in USA. It has been wonderful and very tough: I won't go into the details but will just say that I have learned a lot form the experience, and a lot about what it is that is important to me.

Family.
My family is amazing. I have been lucky to witness my sister and my cousin get married since my return. As well as my father's retirement symposium. I love living next to my brother and being in greater touch with my sister and continually getting to know their partners.


What is Global Health? What am I learning?
My perspective on Global Health is from a social justice perspective. Health care should be equitable for all people and it clearly is not. While I realize that America is clearly not a good example of equity within its own population, my interest are with the disparities in developing countries...partially because I am more fascinated by other countries but also because I think that I can and will have a greater impact on peoples lives there. I am looking at going into global health policy and being an advocate for stronger health care system and health institutions that can better serve those left out of the system. While it is moderately broad...I have come to terms that I am one a generalist, two want to work in policy and management (for the time being), three need to feel as though I am contributing to my mission and values of my life.

29.
I still feel as though I am 12 at heart but I am wisdoming (I have decided I don't like nor will use the word maturity- too many social construct involved that I don't believe in or abide by). I am transitioning and supposedly bringing my saturn back. What that means to me is that I am establishing my community, more interested in reflecting and learning from all of my experiences and carefully mapping out my next steps. Needless to stay, I will always leave myself open to new events.

This year and beyond.
I am going to be going to Thailand for the summer for my thesis. My thesis is going to be looking at health institutions and the impact that migration as on the care, service and perception. It is part of a larger project that has been conducting surveys and studies in this village in Northeast Thailand for 20 years.

Next year, I have been awarded a Research Assistantship (my schooling paid for!!!) from an amazing organization called HAI: Health Alliance Interational. Currently, I am working with I-TECH designing a behavior change curriculum for frontline health workers in developing countries. These are two of my favorite and biggest organizations working in global health in Seattle (besides PATH and Gates).
This Weekend.
I am running my first marathon ever and very excited. There is a group of us that are all marathon virgins and we have been training for the last few months. My legs now make up about 65% of my body mass.
I hope all is well!
Best,
lots of love Noah