Monday, January 19, 2015

แดด [sunshine]

Good morning from Thailand! We cannot believe that this is the start of our fourth week here. They say time flies when you’re having fun, but we both are still in awe of how joyful each day is here. We definitely want to make these last two and a half weeks count!

Our journey to the small market Thursday night for “take-away” dinner was a success. We felt quite independent and even managed to order all our favorite foods in Thai! Megan has mastered the numbers and the names of most the delicious dishes we have tried, so she was a talla noi (small market) expert. We got chicken, and pineapple & coconut smoothies for dinner, and also picked up some fruit and pastries for Saturday’s breakfast before biking home to have a dinner picnic. As an added bonus to this adventure, we met a sweet 4th year pharmacy student in the market! We love making new friends! Our dorm nightlife consisted of more laundry, our picnic, working on assignments, coordinating residency interviews, watching a movie, and planning our weekend adventure to Phu Kradueng National Park!  Note for future students: Completing this rotation block 7 definitely has pros and cons. Pros include the amazing weather, being able to come during Christmas break and extend the visit, and not taking away from completing an American clinical rotation prior to Midyear so that you have more hospital experience before submitting residency applications. The only true con is if you do think you will pursue a residency, as we both are, it can be a little stressful and difficult to plan interviews via email 13 hours ahead of CST. We also do not return to the United States until after interview dates start, so our availability to interview is a bit limited. We are both working through this and the majority of programs have been very flexible with us. Just something to consider! We honestly would still choose to come to Thailand during Block 7 all over again!

Night shopping at the small market

 Friday morning was full of Thailand magic. We got picked up just as the sun was rising at 6:30 am and drove to a nearby lake where we rode a boat to a Buddhist temple called Wat Padon Nad tucked away in a small forest. There are two kinds of Buddhist temples: city and forest. The Thai people call the journey to the Temple “making merit,” where they bring food, water and supplies for the monks that live at the temple. They also attend a service or teaching that the monks oversee. This happens every morning, but most college students attend once a week due to their class schedules. The boat was small but steady, and was operated by a very young boy. Upon reaching the opposite shore, we arrived at a preparation house which is basically a massive kitchen where everyone fixes the offering they brought on trays. These are then carried through the forest, past the monks’ homes, to the temple. In the temple, the visitors line up on the right side while the monks sit on a small stage to the left, with the Buddha statue in the back center.

Food prep room

Monks house

Wat Padon Nad forest temple

The trays are rolled one-by-one in front of the monks, and they select their meal. All remaining food is set to the side and brought back to the kitchen house, where all visitors feast on it for breakfast afterward. This is the only meal the monks eat each day, since monks at temples in the forest eat once meal a day, while monks at a city temple eat twice a day. There were around 50 people at this service and enough food for over 100 people! Everyone sits patiently while the food is slowly displayed for the monks. People can also bring flowers and incense for the Buddha, as well as bowls and water. Once the food is finished being displayed, the monks put a cloth over their plate and begin teaching the lesson. When they finish, the crowd turns to Buddha and reads a two-page lesson (in Thai, of course) that is printed out for them to follow. The Thai reading was so beautiful to listen to while surrounded by such gorgeous scenery and the sounds of nature. While the people complete this prayer, the monks eat. During the prayer, those that brought water pour it into their bowls. This is for loved ones that have passed away. The water is blessed throughout the ceremony and then afterward, one pours the water on the ground. The Thai people believe that when you die, your body returns to the soil and the air, so this water also returns to nature as an offering.

After the ceremony, the monks asked our friends to bring us forward. When we told them we were visiting from America and Japan, they shared their pastries with us. This was a very special gift and gesture. The monk actually had to throw the pastries on the stage in front of him, where we then picked them up, because they are not allowed to touch the hands of others. The monk then told our friends in Thai that we were a beautiful prayer. This was extremely meaningful to us both and we are both very glad we got to share this tradition (Erin actually cried she was so moved).

After the temple ceremony, we ate breakfast and returned home for a quick nap. At 12:30, we went to the HIV/AIDS/STI clinic for children and teenagers at Maha Sarakham Hospital (the same hospital we visited Thursday morning) with our Thai friends Mint, Boss and Best. The clinic is named Ban Rom Yen, which means “shelter house.” It serves 120 patients in the Province. It is two stories. The downstairs floor has a Sex Education Classroom and patient rooms, whereas the upstairs floor houses meeting rooms, a library, and administrative desks. When we arrived, we went to a nice conference room. We were immediately given sandwiches (pandan rolls, our favorite!) and water bottles…again amazed by the hospitality of this country. We are not sure if we have mentioned this yet, but all water bottles are served with straws here! No one drinks straight from the bottle, and if you have water remaining you fold your straw into the bottle before screwing the cap on top. In the conference room, we listened to two very interesting presentations. The first, given by a nurse, introduced us to the clinic and the second, given by a pharmacist, taught us all about anti-retroviral therapy (ART) in Thailand.

In the first presentation, we learned that over 40% of the teenagers in the world have HIV. In Thailand from 1984-2011, there were 376,690 cases (25% people aged 30-34) of HIV and 98,721 deaths related to this infection. The most common opportunistic infections contracted by patients with HIV included TB, PCP, Wasting Syndrome, Cryptococcus, and Candidiasis. 84% of all cases are sexually transmitted whereas a mere 0.03% are from contaminated blood transfusions. The clinic is pretty incredible and offers services such as exercises, massages and herbal therapy, education and teaching, psychiatry, and a fully equipped sexual education classroom that provides free contraception. They have a well-established foreign projects collaboration and have worked with the USA, Japan, Australia, Indonesia, and other countries. They became a one-stop multidisciplinary clinic in 2000, and all HIV medications are provided for free to patients from the national health insurance. Throughout the past 15 years they have also incorporated other events and services such as home health care for end-stage patients, charity concerts, children’s camps for holistic care, HIV safe-sex or protection campaigns for children and homosexual men, and an annual HIV conference. The goals of the clinic are to have zero AIDS, zero HIV-related death, and zero discrimination and the clinic attributes its success to the multidisciplinary teamwork and fighting attitude.

Discrimination is a big problem with HIV patients in Thailand. Not only are children made fun of or ostracized if they have HIV, but also if they are disease-free but the child of someone with HIV. Consequently, people are hesitant to divulge that they have a serious illness and even hid their medication in differently labeled bottles. They also rarely confess to a partner that they are infected. The clinic fights hard to overcome this stigma and to encourage honesty and compliance. Overall they are very successful; only 15% of their patients are non-compliant and have resistant forms of the virus.

Resistance is a huge problem if it does develop because newer HIV medications, such as integrase inhibitors and CCR5 inhibitors are not available in the clinic. The government will not pay for them due to the high cost. NNRTI therapy is first-line. If a patient develops resistance to that, they can move to a PI based regimen, but if they develop resistance to that they have to stay on the regimen unless they can be treated at a larger, regional hospital such as Khon Kaen Hospital and obtain special permission from the government to change therapy. We have the same problem in America…while these medications are more accessible than in Thailand, they are still extremely expensive! Many other practices are similar between our countries, including universal precautions against blood and 28 days of prophylaxis medication for accidental “sticks” in the healthcare setting.

Sex education classroom

At the very end of our time at the clinic, we had the opportunity to speak with two adults living with HIV that were former clinic members and now work/volunteer there. The first, a male, has been living with HIV for 20 years. He stated that he used to be incredibly sick and eventually got tuberculosis, which is how he discovered he had AIDS. He says taking all the tablets in his ART regimen each day is difficult, but that he realized he had two choices in life: take the medication or suffer. He is now extremely healthy and happy. The other patient, a female, found out she had HIV 16 years ago when she was pregnant. In Thailand, all pregnant mothers are screened and if they are positive, they take zidovudine to prevent transmission to the child. Once the child is born, they refrain from breast-feeding and the child takes zidovudine suspension for 1.5 years. This is how long the blood work takes to confirm or deny if the child received the HIV virus from the mother. It was incredibly poignant to hear this woman’s story as we cannot image waiting 1.5 years like that! Luckily, her daughter is 16 and HIV-free, and the mother is doing very well.

The woman in the orange jacket has been living with HIV for 16 years

When we left the clinic, Hannah, Camellia, Airi and Risa hopped in the school van to journey to Surin, where they spent the night before traveling to Cambodia this weekend. We opted to stay home tonight and go on our camping adventure Saturday and Sunday! After a relaxing afternoon of naps, tea on the porch, one last load of laundry, and making progress on our presentations for next week, we went to dinner with Mint and Fern. They brought us to an American restaurant (in their opinion, the best one in town!) where we tried pineapple pizza and spicy chicken pizza. We love hanging out with them and enjoyed our little girl time! Mint even took all six of our white coats home with her so that she can wash them for us, and she brought us hats to help keep us warm at the top of the mountain and some medicines in case we had some muscle aches from our strenuous hike (another interesting glimpse at Thailand’s OTC products)! She is such a sweet and considerate friend!

Later that night, we ventured to the 7-11 to buy some supplies, including peanut butter and bread to make our friends and us some sandwiches for the hike. We may or may not have bought a pint of chocolate chip ice cream while we were there too…oops. We also ran into a professor from school, which was fun! We’re starting to really feel like locals.

Saturday morning was a 4:00 AM wake up call in order to be ready to hit the road at 5:00 AM. Even though it was early we woke up to very exciting news that we both had received residency interviews! What a great start to the day! The National Park was a 3.5 hour drive from our dorm, hence the early wake up call. Responding to emails made us a little late (again…the time difference thing!!) but luckily our friends patiently waited for us (thanks guys!) Tony, Best and Tina met us at our dorm and we hit the road. We stopped for gas, coffee, and road trip snacks right off the bat, thank goodness, because our emailing made us too late to make coffee in our dorm. Erin also made a fun playlist on her iPod, which got the morning started in an even more festive manner.  

Stopping to buy hats at the bottom of the mountain

Due to Best’s excellent driving, we made great time to Phu Kradueng National Park. Phu Kradueng means “Bell Mountain,” which describes its shape. The park entrance fee is usually 400 Baht for foreigners (we jokingly called this the Blonde Hair tax) and 40 Baht for Thai people, but our friends got us tickets for only 200 by explaining that we are exchange students. Finding a parking spot in at the visitors center was actually a little tricky because winter is the best time of the year to do outdoor activities in Thailand, so the lots were crowded. The weather was gorgeous (around 70-75°F on the trail) and got down to about 40° F at the top at night. The ideal hiking and camping temperatures!

Once Tina checked her bag (for 30 Baht/kg, you can have couriers bring supplies to the top for you), we were on our way! The journey to the top of the mountain is only 5.5 km, but it is incredibly steep at times. There are really cool mini villages (also called stations) set up about every 1,000 meters where you can stop for food, drink, and rest. At the first stop, we got ice cream cones (of course…we needed something refreshing!) while our friends ate breakfast. Their breakfast looked so good that we shared a bowl of “rice and omelette” for the first time…this is literally just rice with a cooked egg over it, but the seasoning/flavor is amazing (plus, good energy food for the climb)! While we were eating, the chief health inspector stopped into the hut with a crew from the Ministry of Public Health. He spoke to us for a while and asked to take a picture with us. This was a pretty cool sighting and big honor because his position is very important and respected in Thailand.

After breakfast, we continued the rest of the journey, stopping a few times at other stops for water, sugar cane juice (Thai Gatorade), and other snacks. The last 1,300 meters of the trail is the steepest, but since all of the hikers tend to bottleneck in this area you move slowly up the rocks and it makes the trip pretty manageable. We really enjoyed that as we moved up the mountain, we could distinctly see the different types of trees and nature scenery that changed with the different elevations. We also thoroughly enjoyed laughing the whole trip to the top! Tina kept an extremely positive attitude and starting saying we were “almost there” about a mile into the journey. This became a long-standing joke and will be a special memory. Also, at one point Erin exclaimed “holy moly!” which was an expression our Thai friends absolutely cracked up at and we struggled to explain that moly is just a made up word! Throughout the entire journey, we taught each other English and Thai phrases. Another fun fact we learned: they think chewing gum makes you look friendly and approachable. All-in-all, this was one of our favorite weekends ever and a true bonding and refreshing experience.

Thai people leave sticks or branches under trees to support them and symbolize a long life

Finally, we reached the top!! The entire trail was beautiful, but the top was breathtaking. We took a picture with our Auburn flag, and when we pulled it out Tony, Tina and Best shouted “War Eagle!” without us even asking them to. We were so proud and our hearts were so happy!! At the summit, you can rent bikes because it is an additional 3 km to the visitor’s center/camping area. We opted to just walk and really enjoyed this pleasant stroll. Upon reaching the visitor’s center, we rented two tents, sleeping pads, sleeping bags, pillows, and blankets. The visitor’s center village was so cool…tents set up everywhere with shops and restaurants all around. There are large bathrooms with showers and sinks as well, so it is tent camping with style. This was Megan’s first time ever tent camping, and she loved it!

After setting up our tents, we wanted to go see some waterfalls but after 2:00 PM the camp directors don’t recommend visitors hike the trails because the wild elephants come out. Apparently, wild elephants are not very friendly to humans! We didn’t really mind because we knew we could see the waterfalls in the morning, and also we’re still just in awe of the fact that we’re in a place where we consider things like wild elephants. Instead of waterfalls, we started the trail to the cliffs to watch the sunset. Words can’t really describe the beauty, so hopefully the pictures we have included can attempt to do it justice. We even saw a satellite being launched, which looked like a long-lasting shooting star!!

After the sunset, we walked back to the campsite to find dinner. Tina suggested a family-style dinner where we got to cook soup over a mini-gas stove at our table. We added sesame pork, broth, and vegetables to the pot and allowed it to simmer. It was DELICIOUS and the hot soup was even better due to the slightly chilly night air. Walking back to our tents, we stared up in amazement at the most incredible stars we have ever seen. There is truly no light pollution at the park, so there were so many visible stars. Also neat to think that stars are the same all over the world! We looked for a few of our favorite to find constellations. It was really great to be away from technology and just enjoy the little things in life like the confetti spray of stars in the night sky! Speaking of little things…remember those PB sandwiches we made? They came in handy as the boys got hungry at night and we taught them about the lovely American “fourth meal” tradition.

Sunday morning, we woke up at 4:30 AM to head out by 5:00 to see the sunrise. Again, words can’t describe the beauty of the sunshine fading into the sky. Upon arriving back at camp, we had our favorite breakfast of fried bread with pandan sauce and coffee and then packed up our things. We hiked to a waterfall about a mile away and explored all around. We loved rock-hopping and seeing the incredible views from outside, inside and on top of the falls. It sounds silly, but it is really cool thinking about how all water flows from the tops of mountains. We didn’t see any wild elephants, much to our dismay, but there is always next time :) We left the falls to begin the walk back to the summit and then the trek down the mountain. Going down the mountain was actually pretty easy and we made it back to the car before 2:00 PM. We started at 9:00 AM on Saturday, so in 29 hours we hiked/climbed 28,801 meters, or 18 miles!!

Since we got back fairly early in the afternoon, this allowed us time to chill in a small restaurant at the base visitors center, where we enjoyed coffee frappes and we learned how to say, “everything is very delicious.” This is our new favorite Thai phrase, as it is very fun to say!! Phonetically, it is “eylie eylie gaw ahroy.” Megan said it to the shop owner and absolutely made the woman’s day. We also may or may not have taken some ibuprofen to keep soreness at bay. Inside joke: “Tina, how old are you?!”

We reached the bottom 29 hours after we started! 

Once back in the car, we started jamming to the road trip playlist again. Such a fun time!! We may have been having too much fun, because we got caught in a speed trap. We were going 100 km/hr, and typically the speed limit on major highways is 120 km/hr. However, through the small town we were passing, it went down to 90 km/hr. Luckily the ticket was only about $12 and it made for another memory moment. The Thai police mean business! We explained speed traps in America too, but that our tickets are wayyyy more expensive!!

For dinner, we stopped in Khon Kaen, the bigger city an hour way from Maha Sarakham on our way back to eat at Sizzlers. This is a more American-style restaurant and we were both really excited to see a salad bar with plain vegetables. Erin also got a marinated chicken with a southwest-style salsa, and we realized one of the few things we’re really craving from home is Mexican food! We also found out at dinner that Tina spent time in America through a work-exchange program with Chick-fi-la, so we know how international appreciation for the greatest fast food chain there is. We also found out something else very important to note through our conversation. Nuances with phrasing and languages are difficult to discern, and to the Thai people, “I don’t care” carries a very negative context. They don’t understand why we use it all the time, and asked us to explain the difference in “I don’t care,” “whatever,” and other things we say all the time to our friends when making plans or suggesting things. We felt absolutely horrible because we think we’re being easy-going and flexible when we respond with “I don’t care”!!!! Luckily our friends understood that we were never trying to be rude to them, but we are so glad they told us this so that we can let future students know. Also, we were happy to teach them some English culture about how our friend groups interact. Again…the give and take of learning and laughing is so awesome.

After dinner, we walked around the mall for a bit and Erin FINALLY got to try jasmine green tea with “bubbles”, or little taro-like dough balls that flavor/soak in the tea. It sounds kind of weird, but it’s pretty incredible if you are a tea fan. We were also excited to buy more jackfruit chips. We didn’t realize how late it had gotten with all the fun we were having, and around 8:30 hopped in the car to make the last leg of the journey home because we were “almost there!!” We had so much fun singing (Tony loves Miley’s “We Can’t Stop”, Tina loves Christmas music, and Best is a huge One Direction fan), talking, and laughing. We were sad when we got dropped off and our awesome weekend ended, but so grateful for the opportunity. This wasn’t an adventure we could have gone on without Thai friends, and we are so glad we had this chance!

Jasmine bubble tea!!!

Now it is Monday morning and we are up finishing up some assignments (and blogging!) before we head to a local community pharmacy and another primary care unit this morning. We are ready for an awesome week, and hope everyone back home is enjoying some NFL football and a wonderful three-day weekend.

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