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!