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!

It was quite a trip getting here and I think I’ve finally adjusted to the time difference.  I arrived in Umphang on Friday where I will be staying for the next three and a half weeks.  Umphang is located in Tak province in the northwest area of Thailand.  Though it’s a remote area and a small community, its resources are amazing.  I am staying in one of eight ARC guesthouses in Umphang with one of the Thai ARC employees.  There is city power so electricity is not an issue--no getting ready with a headlamp.  We not only have clean running water, but there’s a hot shower too!  The washing machine is broken but the spin cycle works to help dry clothes and there’s satellite TV.  Around the house, there are several markets and small restaurants that make great Thai food and where I can buy a large variety of fresh fruit and vegetables.  Things here are also very cheap, each meal costing about a dollar or 30 baht.  

 These are two pictures from my run in Umphang this morning, pretty gorgeous scenery.

I spent this weekend getting acquainted to my new home and surroundings with the help of Jenny.  Jenny is the second year family planning fellow at Hopkins who has been here for just over two weeks.  We’ve been planning things out prior to the trip and its so nice having her here.  This weekend we were able to walk around Umphang on Saturday to see our neighborhoods and to find out about trekking at the nearby waterfall.  We were able to arrange for a one-day trip on Sunday and went to ThiLoSu waterfalls, the largest in Thailand and sixth largest in the world.  We first rafted through MaeSuk River and stopped to experience one of the hot springs nearby.  We then took a 45min ride in what I called the Death-mobile to reach the falls.  The road to the falls was just opened after two days of no rain.  Most of the road is mud and going up and down hills in the mud was more than treacherous.  We slipped several times and I thought we were going to tip over at least twice (sorry Mom).  Luckily we made it there safely and heading home was not as bad.  We were also able to stop by a Buddhist temple on the way home which are very common in this area.

 Jenny at a local fruit stand

 Inside Umphang welcome center with some monks hanging out listening to their iPod

 Outside Umphang welcome center

 Thi Lo Su falls

 Our muddy feet walking around hot springs (Jenny's are a bit camouflaged)

 Thi Lo Su

Buddhist Temple on the way back to Umphang

More later this week on Umpiem camp and my first week getting settled there.  Today was my first day and it was pretty incredible.