Sorry no more pictures from this point on, I left my computer in Bangkok so will download what pictures I take when I get home in two weeks. Right now I'm in Ko Lanta, an island of Thailand in the Andaman Sea. Its low season so very quiet but just what I need after sightseeing and lots of stimulation in Chiang Mai and before surf camp in Bali. I left Chiang Mai on Sunday, stopped ore in Bangkok before arriving in Krabi. I have to think really hard about the days... A sign that my brain is taking a rest!! I stayed in Ao Nang outside Krabi for two nights which was great. I was in a quaint guesthouse down the street from the beach which was safe and friendly. I took a tour on Wednesday to hot springs, the Emerald Pool, and finally to the Tiger Temple. I got quite a workout climbing the 1234 steps zigzagging up the side of a mountain to reach a huge golden Buddha at the top and a spectacular view. Thankfully it rained as we trekked down the steps- I made friends with a couple on the way down; we cheered each other on as we worked our way down the woman and I shared a fear of heights. Well it was well worth a few minutes of shaky knees and quickened breathing to get to the top! It's been great timing for me to learn about Buddhism both thru these tours and by reading the Dalai Lama's latest book. From what I learned, Buddhism is focused on love, compassion, and serving others despite the suffering we experience as humans with "untamed minds". The practice of meditation aims to heal our minds from disturbing emotions and serving others helps us get out of our heads. I've also been ready a book on Christianity and it's been pretty amazing to piece these things together and see how I can apply these ideas to my own life. I know service has been a huge classroom for me in the last two years and I'm excited to get home to give service in Atlanta- I hope if youre inspired at all by my blog you can find some volunteer work in your community too! So after four days of sun, snorkeling, reading and spa time, I leave for Phuket tomorrow and fly to Bali on Sunday. Wish me luck and lots of strength for surfing!

Chiang Mai

Tha Pae Gate into Old City

 The gate (what's left of it) surrounds the entire old city in a large square and just outside, a reconstructed moat lines the gate.

I spent the first day pampering and the second day walking.  I walked all around the old city and visited several of the Buddhist temples.  Wat Chedi Luang was the most impressive.  Tomorrow I'm taking a tour up to the mountains to see one of the ancient temples and the surrounding area.

 Today I spent the day at Asia Scenic Cooking School and it was sooo much fun!  They picked me up at my guesthouse and took me to the school in Old City.  I was introduced to my group that I would be with for the day.  Go figure, I get paired with a family from NEW JERSEY!!  And a really nice couple from Holland.  We all got along well, enjoyed learning from each other, trying each other's dishes and sharing stories of traveling around the area.  We each got to choose 6 dishes to learn and all dishes were included in a nice cook book we got at the end of the day.

 Our teacher first brought us to the market in Chiang Mai so she could explain different types of rice, noodles, chili peppers, tofu and how to buy them properly in the US.  We then drove to the farm where we learned about the different herbs and vegetables used in Thai cooking and how to substitute if they're not available where we live.  I'm counting on the Dekalb Farmer's Market to keep my Thai cooking going!!

 We first learned how to soak rice and the differences between cooking sticky rice and jasmine rice.  I have some tools I need to buy before I head home!

We each got to choose an appetizer--I picked papaya salad which I LOVE LOVE LOVE!  I'm crushing  the ingredients above in the mortar.  Luckily I got to also try the spring rolls made by two of my new buddies (rolling them up here).  I don't usually like spring rolls from what I've tried in the US but these were really good and easy!  

For my stir fry dish, I chose pad thai of course.  That's my dish below!!

 We had a lot of fun working with each other.  For our second meal of the day, we chose a soup and curry paste to make.  The curry paste took some time as we had to take turns crushing all the ingredients into the paste.  We then added the paste to coconut milk in the wok and other herbs, vegetables and chicken.  It was really good, I'm so excited to make the things I've loved here at home!!

 

The other pastes we made were panang and red curry, masaman and khaw soi (popular in Chiang Mai).

I need to buy a wok and some ingredients I might not be able to get at home.  Mom, Dad get ready. I'll make you dinner to say thank for taking care of Rio when I get home!  Hopefully everything turns out as well as it did today.

 Final meal (dinner)..my soup, jasmine rice and green curry.

New buddies!!  

Last Days in Umpiem

So last week I finished trainings with CHEs on Friday.  We spent a few days on family planning and we had a lot of fun.  Lots of these pictures are of the group watching a video on IUD insertion and then playing the IUD models.  They were really excited at the possibility of ARC introducing these methods into their clinic.  Several of the female CHEs offered to be patients if I had any insertions to demostrate.  Unfortunately I only had demo models!

 

 

I finished with the last midwife session on Monday and also got to go thru a delivery with three of the them and everything went smoothly. They were very grateful for having the trainings and it was great to work with them.  Hopefully they will undergo FP competency-based trainings to add to their skill set.  The camp has several vocational training programs like cooking, sewing, agriculture so that the refugees can be trained to work while they live in Thailand but so that they also have skills for a job if and when they resettle.  Here are two pictures of Eh Paw and Snow who did the delivery with me (see the rain boots on the ground they use instead of throw-away booties to protect their feet).  Aye Aye Hwyate is in the second picture swaddling the newborn.  

I was soo sad to leave South Sudan last year.   I think it was a huge eye-opener for me under a lot more difficult of conditions so leaving was really bittersweet. This year--maybe its the vacation that was awaiting me-- I wasn't sad to finish but really just happy to have had this experience and excited  for changes to hopefully come to the camp.  

I am also really happy that I'm not heading straight home and getting to explore a bit.  Thailand, from the small amount I've seen so far, is incredible.  The people, the culture, the food, and the energy is great.  I just got to Chiang Mai today after a 4 hour drive from Umphang to the Tak bus terminal and then a 3 hour bus ride.  I celebrated my first day with a pedicure followed by a massage and facial.  Oh my Chiang Mai!  I'm seriously in heaven.  I know it sounds decadent but in the US I could have had dinner for more money.  

Tomorrow I'm going to tour the old city that's surrounded by a moat and gate and see some of the temples.  I'm reading a book by the Dalai Lama and might go to a yoga class tomorrow (when in Rome...).  Friday I'm super excited to be taking a full day cooking class at a local farm.  I should learn 6 dishes and get a cookbook so hopefully I can replicate some good stuff for yall when I get home!!

Will post some pictures soon!!  I'll be here till Sunday then fly through Bangkok to Krabi and the islands

Lunch with the CHEs

No pictures for this post but I wanted to share about my lunchtime chats with the CHEs (Community Health Educators).  I've been doing training sessions with them this week discussing family planning and possible barriers to long term methods like IUDs and implants in the camps.  We have a two-hour session each morning and then we break for lunch before I head to the other camp zone to work with the midwives.

Each day they invite me to lunch and I gladly join them.  There are a few who speak a little English so I can ask them about their experiences as refugees.  Today, I learned that the CHE leader has been in Umpiem for six years and has never left.  My other buddy, has gone out to Mae Sot for weekend trips but hasn't left in over a year.  They're allowed to leave camp with camp leadership permission for up to three days.  If they leave without permission, they have to sneak out and hike over the large mountains on the back of camp and make it to one of the roads.  Some do this in order to work in the farms around Umpiem and make more money than they would in the camps.  If they get picked up by Thai police, they would be arrested and brought to the Thai border police.  If they have family that can pick them up and bring money, they can be released and may be allowed back into the camp.

Going back to Burma isn't an option for them even though many of them would like to.  Most of the CHEs fled because they had been arrested or were going to be arrested for their political beliefs.  Two of the CHEs I've spoken to have been arrested for organizing peaceful protests for democracy in Burma.  One stayed in prison for one year and one was in for three years.  Once released they fled to the refugee camps with their families.  Because they were political prisoners, they were seen as a great threat in prison and were kept from communicating with any other prisoners, so they pretty stoically state that it was a really hard time.

Today, I also learned that CHEs in camp make 1200 Baht per month.  Thats $40.  It made it difficult for me to enjoy the homemade chicken soup they made me knowing that they make that little and yet they have given me sooo much so freely this week.  When I get to the CHE room, they scurry around to make me coffee and get me a chair and put my bag away-it feels a little ridiculous.  But I don't want to insult them either so I try to accept whatever they want to give me with gratitude.  I think that's one of the big reasons I've enjoyed doing trips like this.  Being here gives me great perspective on how lucky we all are to share experiences with one another.  To see how other people live and how they can be happy is a great gift.  One of my favorite quotes from Abe Lincoln is:  "People are about as happy as they make up their minds to be."

Days in Umpiem

I finally started midwife trainings last week.  Activities in the camp keep the midwives busy so there was a deworming campaign at the beginning of the week, World refugee day on Wednesday and food rationings in the morning another day.  So my time with them is limited.  On Mondays like today, RCH is closed so I have the whole group all day but the other days I am only with them in the afternoon and spend mornings preparing or with the CHEs.  We have split midwives into two groups so that one group can continue working in the RCH clinic while the other group does training with me.  Last week I was able to watch the midwives in RCH distributing rations and doing nutrition counseling and distribution of deworming medications including vitamins.  Rations included canned mackarel, beans, oil, salt and soap.  

Here are some pictures from midwife trainings.  First, the staff room, then their "labor lounge" of sorts and us in the training room.

This is the scale used for growth monitoring for kids in the RCH clinic.  And a really cute Burmese kid that was having a ball playing with a toy.

Last week I also made a few visits.  I went to Umphang Hospital to visit with Dr. Worawit, a Thai doctor who has dedicated his life to providing care at the government hospital.  I wanted to discuss IUDs and Implants with him.  He says there is a trained nurse who does do implants and IUDs but they are not very popular and expensive.  He is also trained in insertions and removals and well as tubal ligation and vasectomy.  He is a general practitioner but since he works at Umphang he must be able to cover surgery as well including the c-sections.  There are five doctors for the entire hospital.  Four are junior doctors, kind of like residents working in general practice and there is also one pediatrician.  In Thailand, after graduating medical school, doctors have to spend two years in provincial rural hospitals providing care before going on and specializing.  These four juniors are expected to work in the clinics, ER, perform surgeries in emergencies and also schedule surgical cases when they can.  If a patient needs more specialized care, they are referred to Mae Sot or they arrange for a specialist to come to Umphang for one week and work like crazy seeing all the cases in that specialty for the week.  They tried convincing me to do a myomectomy that they’ve held off doing because no one has done one before.  I said no even though I’d love to help.  The thought of operating with a staff that doesn’t speak English is scary especially for a case that has a high chance of bleeding.

Dr. Worawit showed me his maternity kit he takes with him when he gets a call for a woman with obstructed labor in the village.  He has the tiniest pair of baby simpson forceps I’ve ever seen that he’s used for the last twenty years.  This would be a great hospital to work.  He invited me to come back and he would have a place for me to stay and would feed me.  The junior doctors still act as “house staff” living in quarters behind the hospital.  Its definitely tempting—I would certainly gain a whole new set of skills.  I haven’t seen MSF here (Medicins sin Frontiere aka Doctors without Borders) but this would be a good site for placement.

I also visited Planned Parenthood of Thailand in Umphang to discuss their services.  They also have a nurse trained in IUD and implant insertion but she echoes what Dr. Worawit said—not popular and too expensive.  So these are the main barriers that will need to be addressed.  I’ll get started by talking with the midwives and CHEs during training to address the community barriers, perceptions and possible ways to reeducate the community on these methods.  As far as cost, that’s something I’ll discuss with ARC.

Socially, my life is not so exciting!  The most English I hear is on the TV.  I have been able to enjoy the quiet though and relax.  I’m reading a lot, have enjoyed some runs in the rain and have just gone out walking through town.  I definitely get stared at running but the people here truly are kind and really gracious.   

I don't know if you can tell in the first two pictures up on the left but the hills here are ridiculous.  Heat, hills and humidity, welcome to Umphang (and wild dogs).  They've (the hills and the dogs) made runs challenging but its been great to get outside and take in the sites.  

This is a picture from Jenny's last night with ARC staff.  We got a cute gift from them, ARC bucket

 hats and baseball hats and t-shirts.  Jenny left for Myanmar last week so its been quiet since.  

There's no way my pictures can capture how amazing the landscape is here.  On the way to Umpiem (when I'm not sleeping to avoid nausea), I just stare at the rain clouds forming off the mountains.  

In Umphang, its gorgeous seeing the mountainous backdrop with lush green everywhere and then a surprising bold flowers in bright colors.  The houses are also gorgeous, mostly teak from Burma.  The one below is the TBBC house (Thai-Burmese Border Consortium) but the others are from my house.

 And there's my room, with my mosquito-net-encased bed, my desk and my yoga mat, doing my hip rehab exercises every day (thanks Scott!) I think I'm getting stronger!!  I'll be ready to play soccer again when I get home, fingers crossed.

The other thing I've been doing in my spare time is planning my vacation which starts next week!!  I'll be heading to Chiang Mai next Wednesday to do some shopping, take some Thai cooking lessons, visit some temples and whatever else there is to do.  From there I fly to Krabi which is in the south on the Andaman Sea.  I'll stay two nights there and will walk around, maybe go rockclimbing and take a ferry to Kho Lanta one of the islands.  I'll ferry to Ko Phi Phi (where "The Beach" with Leonardo DiCaprio took place) and spend a night before heading to Bali.  Sooo excited, I signed up for a week surf camp.  After that, I think I'm going to go to Cambodia to tour Angkor Wat.  Please send any book recommendations!!! Martina, already read thru On the Island, it was good!

Intro to the camps

  Views from the drive

This week I got to visit Umpiem and Nu Po camps, which are the second and third biggest camps on the Burmese border.  Both camps are about a two hour drive from where we all stay in Umphang so we have a driver take us both ways each day!!

 

 

Here are views from the inside of Umpiem

The homes are made of bamboo and they're incredible. Umpiem houses just over 17,000 refugees.  There are 16 sections each averaging 200 households.  The people speak Burmese or Karen and identify as Buddhist, Christian or Muslim.  

Korravarn and Anne are the Assistant and Head RH Coordinators for ARC Thailand and will be helping me arrange midwife trainings in the next two weeks for EmOC (Emergency Ob Care).

The Microenterprise system set up in the camps is a Yarn Bank where women can borrow yarn for use in making sarongs and clothing that they can then sell and reinvest into the bank.

I spent the first day at Umpiem getting acquainted to the ARC services offered including RCH (Reproductive and Child Health), Sanitation, Micro-Enterprise and Labor and Delivery.  

Delivery Room at Umpieng 

Inpatient ward at PU-AMI (French NGO)

 Typical latrine with flush (aka pot to pour water)

On Tuesday, I went with Jenny to Nu Po to see the camp, watch one of her midwife training sessions.  Midwives here are not CNM (certified nurse midwives) like in the US but go thru a four month course thru ARC to be considered competent for midwifery.  They then progress thru four levels of clinical work over the next year.  We were able to help out with a delivery and get a little dirty that afternoon.

The homes are well decorated with gardens

On Wednesday, I started introductions with the CHEs (Community Health Educators) who I will be doing a few training sessions with.  They are so happy to have trainings and treat me with so much kindness.  They made me breakfast and lunch today and took me on two home visits to discuss malaria with the two families.  So far we've discussed the camp community and reviewed vaccinations today.  

 Rain rain, lots and lots of rain.  I have my umbrella with me always.



On Wednesday afternoon, Jenny and I went to visit the Camp Leaders (Leader, Asst Leader and Health Coordinator) at Umpiem to encourage the introduction of misoprostol, IUDs and Implants which they were supportive of.  We also visited with the KWO (Karen Women's Organization) to get their support as well.  Success!!  PPH (postpartum hemorrhage) is the leading cause of maternal death worldwide and a cause for frequent referrals outside the camp for expensive services (including incomplete abortions).  Hopefully introducing misoprostol will improve the RH care women are receiving in the camps. We were really happy after our meetings!!  Now we just have to figure out how to get the medicine here and I can start talking about it in midwife trainings.

There is concern that introducing IUDs and Implants and placing them in refugees may cause problems when they leave the camp.  Who will remove them and what if there are complications?  So we met yesterday with a British NGO that trains the "backpack medics" that serve the communities on the border in Thailand and Burma.  We reviewed the Burmese Border Guidelines that they use and will continue to work with this group to coordinate training their medics in IUD and Implant use, removal and care of complications.  Hopefully a future fellow will come to Thailand to do this!!  (Anna are you reading this?!?)

Today I made home visits with some CHEs and also visits Planned Parenthood of Thailand.  They used to place IUDs and Implants but lost funding.  I have a meeting next week with their headquarters for Umpiem to see potential barriers or concerns for introducing these methods in the camp.  Next week I'll also start EmOC training.  We're getting a lot done in a little amount of time but hopefully someone will come after us to keep moving things forward!