Friday, October 29, 2010

Photos of Mae Tao

Me and Tender!
Reproductive Health Inpatient Department
Labour and Delivery
The crew in the In-Patient Department

Here are a few glimpses of the clinic!  I've put more photos on an album which can be viewed at:
http://picasaweb.google.com/lh/sredir?uname=100753240463516732655&target=ALBUM&id=5533677052082055473&authkey=Gv1sRgCK3zwM_rlpTbWw&feat=email

Hope you enjoy!  love, Laura

Our common beginnings

I can't believe that I"ve been here four weeks already!  It feels like both a blink of an eye, but also a lifetime of experiences in such a short time.
For the past week and a half, I've been working in the reproductive health department, seeing new moms and babies, and getting to do some deliveries myself!  Apparently, there are ten deliveries in the average day!  I quickly attached myself to one of the senior midwives named "Tender" who has delivered over 2000 babies in her time at the clinic.  She is quite a force to be reckoned with, and has such a wonderful way with pregnant women.  For instance, during the most intense moments of labour, she sings the clearest note that  focusses the woman's energies perfectly in a way I can't express.  I've also seen her perform a "nipple massage" in order to strengthen uterine contractions!  The birthing conditions are very basic - no pain medications, no sheets on the bed, but a decently sterile environment, and midwives whose good judgement comes from much experience.  This has really served to normalize the birth process for me, and I now have an even deeper appreciation for the wisdom and power of the female body!  At the same time, I am also realizing the huge importance of good basic reproductive care - family planning services and safe birthing environments.  Aside from the many women who make it to the clinic, there are also many who don't.  Maternal mortality is significant in Burma, and it is still all too common to see babies with tetanus from umbilical cords cut with unclean knives, or women suffering the complications of failed self-abortions (abortion is illegal in bothThailand and Burma).
How many different realities exist in this world!!!
My Dad asked me, the other day, whether all of these intense experiences are impacting my mental health, and said that he hoped I wasn't becomming too emotionally burdened by it all.  There certainly are many intense moments in these days, but to be honest, the effect is actually the opposite.  The stark reality of death amidst life and birth... even senseless, preventable, unjust deaths, are a normal part of life here.  I"m not saying that this is the way it should be, or that the injustice should be accepted, but that death and illness are part of life - no less so in the West, though its faces look different, and we may prolong or hide this inevitability more successfully.
I"m looking forward to my last two weeks here, whatever they may bring!  I'm learning not to underestimate the life that can be lived in two weeks!  Thanks to all of you who have been sending me love via phone or email - I really appreciate it.  I'll try to write again this weekend, and post some pictures of Mae Sot and the clinic.
Much love,
Laura

Sunday, October 17, 2010

A Medic's Story

"The greatest journey that one can make in their life is the journey from the head to the heart"

Burma has been under military rule since 1962, when a military coup overthrew the civilian government.  The current military government has been in power since 1988, disregarding the results of a democratic election that would have put the National League for Democracy in power.  The party's leader, Aung San Suu Kyi has been under house arrest for nearly two decades, and remains an important icon for the pro-democracy movement in Burma.  For the rural people of Burma, this military rule has meant decades of abject poverty, violence and displacement.  Sacking of villages by the military and other guerilla groups is widespread, as well as forced labour and sexual violence towards women.  Many rural Burmese, as well as members of other ethnic minority groups (such as the Karen) have joined armed resistance groups, and thousands have fled across the border into Thailand.
Sitting around a table in the inpatient ward last week, nearing the end of the day, Jonny Soe, a young Karen medic in his early twenties began to tell me pieces of his story...  Jonny fled Burma nearly a decade ago, and lived in a refugee camp on the border for four years before coming to live at the Mae Tao Clinic and training as a medic.  He, like the dozens of other medics and health workers at the clinic, lives far away from his home and family, a refugee from his own country.  The medics are given a place to live at the clinic, but as non-citizens, they are unable to travel or to work for income.  They are given 1000 Bhat a month for food and other necessities (about $30), and spend their time working, learning english and computer skills and, for many, applying for refugee status to countries like the United States or Canada.  Many hope to eventually return to their home communities in Burma.
Jonny tells me how many of the medics struggle with depression, facing daily encounters with their people's suffering.  He tells me how hard it is for him to see young people die, hard to face a very ill man who is afraid of leaving his wife and young baby without support, hard to see people arrive with nothing but their clothes, and be unable to give them even a blanket, let alone definitive medical care.
I cannot believe the lives that these medics live, cannot fathom what they have lived through already, what they face every day, and what keeps them going.  I ask Jonny what he does when he feels sad and he says that he "just forgets".  
At the same time, it is remarkable the generosity and comraderie that exists within this ragtag community of medics.  The other day a young woman was admitted in a coma.  She had soiled herself, but had no other clothes to be changed into, so one of the female medics bought her an extra pair out of her own pocket.


I often find myself totally unprepared for the barrage of emotions that accompany this work.  As the intellectual statistics of war, displacement, illness, poverty begin to take shape in the form of faces, individual lives and stories, I feel a strange mix of layered emotions - numb, then sick, then angry.  Odd, the places my emotions occupy when I am afraid to feel them.  For a few moments, I glimpsed myself through  Jonny's eyes, my unfathomable freedom and privilege - material, geographic and political.  This is a confusing and uncomfortable space to be in, but it would not be honest not to feel these things, not to ask these questions.  What is my relationship to this suffering, these lives?  And, a line from a book I am reading (the Lizard Cage) that embedded itself in my mind, "how can a well-fed man relpy honestly to another man's hunger?"

Thursday, October 14, 2010

and some photos: my home, the clinic, and Sukothai




Week two in Mae Sot

It seems like a lifetime has gone by since my last post!  Life in Mae Sot has settled into a nice routine, full of interesting encounters with local people, challenging and rewarding work at the clinic, and a good group of fellow foreigners who remind me how wonderful it is to speak in my mothertounge and be understood!
A day in the life goes something like this: wake up under my mosquito net to the sounds of roosters, traffic, and neighbors, bathe, find some food for breakfast (theres a little burmese noodle shop just outside my home), and get on my bike to head to the clinic.  On the road, I pick up Alex, my fellow medical student and best friend here,and together we ride past fruit stands, stray dogs, trucks, and rice fields about 5km to the Mae Tao Clinic.  The clinic is always bustling, and after drinking a coffee with Alex at a little stall on site, we head to our department to see patients.  Ive been working in the adult inpatient department these first two weeks, seeing various patients who are sick enough to stay in the clinic. Most are Burmese, either from across the border, or illegal immigrants to Thailand.  Free health care is provided to Thai citizens, but as illegal migrants, these people have no access to other services. Its been an incredibly steep learning curve - figuring out what diseases are common here, what labs and medicines are available, how to chart - not to mention the cross-cultural learning!  Most of the medics Ive been working with are Karen refugees, trained by the clinic in their "community health worker" training project, and they are both useful translators, as well as excellent clinicians.  Ive been amazed by their clinical skills and judgement... I guess thats what happens when one has to rely solely on their own two hands and their mind for diagnosis.  For the first time in my training, I find myself using my basic clinical skills and observation - skills that have been made nearly obsolete by medical technology in the West.  It is challenging me to think critically and thoroughly, to use testing judiciously, and to be firm in my decisions.  I work as a team with the medics, problem solving, learning and teaching in turn.  As the days go on, Im beginning to feel more comfortable and more useful. 
My heart has been doing some learning and growing as well at the clinic... seeing diseases of poverty, and conditions that would have been nipped in the bud months or years before in any Western country.  There are many things that we cant work up to diagnose, let alone treat.  So, patients languish with family members sitting beside them on the hard plywood beds, people eating, conversing, laughing, babies breastfeeding as people heal or pass away.  The great chaotic, senseless, beautiful dance of birth, life and death is all happening here, between these concrete walls.
Im happy here, learning and feeling and reflecting on the things I witness, both difficult and beautiful.  Its a gentle life too, and Im revelling in being just a small, curious human with much to learn - listening to the rain, taking in the smells, the stories of this place.
thinking of you all, with love, Laura

Sunday, October 3, 2010

Welcome to Mae Sot!

After a long busride (on a double-decker no less!) from Bangkok through rural thailand, and over a jungle-covered mountain range, through two police checkpoints, it was with some surprise that I rolled into Mae Sot yesterday evening - surprise that the long journey had gone so smoothly and that I was finally here!  The adventure, however, was just beginning!  Mae Sot is a bustling border town, made up of 98% Burmese people, with a good splash of foreign NGO volunteers.  Accordingly, after my shmancy iced coffee this morning (in a cafe that no local could afford, though it only cost me $1.30), I took a walk through the market, overflowing with tropical fruits and vegetables, clothing, buckets of toads, eels, and turtles, and any other local delicacy you could want.  Apparently, there is also a thriving blackmarket in gems, drugs, and guns that come over from Burma, though there were obviously no sign of these.  I bought some custard apples and was told that I'm beautiful. Though everyone is very polite and keeps their hands and coments to themselves, I'm remembering what it's like to be a spectacle - an amusing, awkward, clearly monied foreigner who probably looks quite sweaty and lost at the best of times.  I'm okay with being looked at and whispered about - I just wish I could communicate with people and break that very present invisible wall.  Smiling is a start, I guess.

I checked in to a guest house, and made quick friends with one of the Burmese guys working there, Than.  He seemed a bit hesitant to register me for more than two nights, which confused me, until he pulled me aside this morning and drew me a pencil-sketch map, with the name of a shop and the man I was supposed to find there to ask about a cheaper "homestay".  Than was quite adamant that I keep this plan from the Thai owners of the guest house, who would fire him for losing their business.  So, today, I showed up at the appointed time and place and, sure enough, met "Bobo" who drew me another map.  Down a back alley, past some street dogs, I asked an old woman, and was led to a very humble home behind a temple.  The woman there showed me the room I am to rent, and meanwhile chattered at me in Burmese, assuring me that she would teach me the language while I'm living with her.  So, I've found my new home!  Though it's markedly less fancy than the guest house, it's $3 a night (as opposed to $10) and it will be a pleasure and a privilege to share space with a Burmese family and learn from them.  It's amazing, the network that exists here, and I feel that there are many invisible hands and eyes, looking out for me already.  It's quite comforting.  I guess anyone who comes to contribute to the work being done around here for Burmese Human Rights is quickly considered a friend and ally.

Speaking of which, I've been doing some reading about the political situation in Burma and the terrible oppression (economic, political, physical) that has been going on for the last three or four decades.  It's really shocking and disturbing - not least the lack of international awareness and action on the issue.  I"ll post some articles at the end here, for anyone who is interested.

Tomorrow, I'll make my way to the clinic!  I'm really excited to be here.  A few people asked me, before I left, why I was coming to Thailand, and I didn't have a great answer.  But I can say now that this feels like where I'm supposed to be at the moment - and that's a good feeling!  More to follow...

Love to you all, and hope all's well.

http://www.nytimes.com/info/myanmar/
http://www.nytimes.com/2010/03/30/world/asia/30myanmar.html
http://www.nytimes.com/2010/05/02/world/asia/02myanmar.html
http://www.nytimes.com/2010/08/14/world/asia/14myanmar.html

Wednesday, September 29, 2010

The adventure begins... or continues!

Well, somehow, amazingly, probably through the sheer force of chaos, things seem to have come together in time for my departure to Bangkok tonight!  This morning, I submitted my CaRMS applications for family medicine residency next year (location to be determined), said goodbyes to relatives and friends, and even made it out for a run in the beautiful Edmonton rivervalley.  The colors are incredible right now, leaves fallen and falling all around, and the smells... I breathed in as deeply as I could, trying to take in as much of this beauty as possible, so that maybe some will come with me on my travels around the world.
It's times like this that I wonder why I'm leaving the places and people that I love and the relationships that ground me, and planting myself in yet another foreign context.  I've come up with no answers yet, but there's some whisperings of adventure, growth, exploration.  It's like that fish, being pulled out of water, that suddenly realizes "holy moly, I'm a fish!  and that's water!" - sometimes it's when I'm most out of my element, that I find the most clarity.
So, I"m off!  Love to you all.