A visit to Roi Et.

Bordered by Cambodia to the southeast and by Laos (and the Mekong River) to the north and east, 'Isaan' is what the Thais call the large tableland on the Khorat Plateau in the northeast where nearly a third of the nation's population lives. The name comes from Ishana, the Hindu god of death, possibly referring to the infertile soil and a climate characterized by long periods of drought punctuated by downpours and flooding. However, agriculture is the largest economy, generating 22% of the Gross Regional Product (GRP). Rice is most prominent, however, an increasing number of farmers are converting to cash-crops such as sugar cane and cassava (manioc). And, in the middle of Isaan lies the sleepy countryside city of Roi Et. Home to 40,000, it is also the capital of Roi Et province. The term Roi Et translates to 101, which derives from the 11 satellite colonies around the city and the 11 gates of the roads that lead to the towns, and it is thought that the number was exaggerated.

Roi Et city and province are known for crafting 'khaen', an Isaan musical panpipe made from reed and wood. At the center of the city lies Beung Phlan Chai, a symbolic 200,000 square-meter artificial lake with an island in the middle that houses the city pillar shrine. Locals can been seen lighting candles, sitting on their knees, and giving prayers. Adjacent to the shrine is a park with a large playground and lawn with some sculptures of art, exercise area with equipment, as well as a running track. On any sunny day afternoon, after the day has cooled a bit, locals can be seen picnicking and playing around with their families, while some can be seen jogging with their portable music players. To the southwest of the lake is a small public aquarium, the only one in Isaan.

Walking north on Thanon Haisok and turning left on Thanon Phadung Phanit, walking about half a kilometer before turning right on a small dead-end alley will lead you to Wat Neua, which means 'the north temple'. Appropriately situated in the northern quarter of the town, Phra Satup Jedi, a 1,200-year-old chedi from the Dvaravati period, is what makes the temple special, though its tranquil atmosphere with its quiet garden and occasional humming of birds that helps you relax is what I enjoyed the most. Nobody was seen, not even a monk. Buddha's representing the days of the week are housed in the corridor surround the chedi, but no traces hinting they have been cleaned regularly could be seen. The chedi here boasts an unusual four-corned bell-shaped form that is rare in Thailand. Around the 'bot' are a few old Dvaravati semaa, or ordination-precinct marker stones, and to one side of the wat is an inscribed pillar that was erected by the Khmers when they controlled the area during the 11th and 12th centuries.

Strolling in the opposite direction on Thanon Phadung Phanit will take you through a couple of local shops and banks, before a tall standing Buddha easily towering above the minimal skyline of the city jumps into your view. Located near the eastern edge of the town, Wat Burapha Phiram, a third-class royal temple which was formerly known as Wat Hua Ro, houses the tallest standing Buddha image in the country known as Phra Phuttha Rattanamongkhon Mahamuni, or Luangpho Yai or Phra Sung Yai in short. The Buddha is 59.2 meters tall and if the base made from concrete is included, it would be 67.8 meters. Near the base of the Buddha is an outdoor museum that displays figures telling the story of the Buddha. Unlike the almost-forgotten temple of Wat Neua, Luangpho Yai seems to be highly revered by the people of Roi Et.

Walking south on Thanon Phloenchit will lead you to the busiest part of town, with some high-class hotels and a shopping center, though the large and lively market is definitely what draws the most attention. No, there isn't anything special about it, and it resembles any other ordinary market found in most Thai cities. However, you won't be bored watching locals selling their fresh goods or cooking meals the smells of which will make you drool, and other locals come and go, probably collecting the ingredients to make their supper. And for me, this is the first place I had 'khaw-niaw ma-muang', now my favorite Thai dessert, which is coconut-milk-steamed sticky rice topped with thick slices of fresh mangoes and additional sweet coconut milk poured on.

Is Roi Et a must-go place on a tourist's list? Probably not. But to relax and savor the atmosphere unique to Isaan, it might be worth spending a couple of days. :)

Strolling in Luang Prabang.

Between the mountains covered with jungles in north-central Laos lies the city of Luang Prabang. It is situated where the Nam Khan River flows into the Mekong River, well over 400 kilometers north of Vientiane. Every dawn, lines of monks dressed in orange robes walk through the streets to collect alms, and along with the Buddhist temples and the simple concrete buildings, the atmosphere seems to resemble that of its neighbor Thailand at one glance. Even the language is very similar to that spoken in 'Isan', the northeastern part of Thailand. The cuisine is similar too; Tam Mak-Hung (papaya salad) is basically the same as Som Tam, and they eat that with Khao Niaw (sticky rice), and it even goes along with Kai Yang (roasted chicken).

However, if you look carefully, the decorations of the temples are different, architecture reflecting the days of French colonization still remains in many houses, and most of all, its social systems, including education, health care, and welfare is like those of its neighbor decades ago. Education is essentially free for public primary school (five years), junior high (three), and senior high (three), but the percentages of children enrolled are 84.2%, 54.4%, and 34.2%, respectively. And, since the country does not keep track of personal identification records, the actual age a child gets enrolled varies. The number of years for university education varies from two to seven depending on the majoring subject, however, none are free. Free health care is not available, but government aid may be issued if you travel all the way down to Vientiane and ask for it.

I paid a visit to this landlocked country in the Indochina Peninsula in August. Registered a World Heritage Site by the UNESCO in 1995, the compact city of Luang Prabang is a nice and calm place to spend a couple of days. Besides the symbolic temple of Wat Xiengthong and the hill of Phousi, where you can get a picturesque view of the entire city, there are many so-called 'speed boats' that take you up and down the Mekong to various nearby villages and the buddha-adorned caves of Pak Ou, while 'songthaews' or 'tuk-tuks' (same nomenclature as Thailand!) can take you to the beautiful waterfalls of Tat Kuangsi. At night, nearby villagers, including the Hmong, come out to sell various goods, creating a bustling street market scene.

The recent influx of tourists to this economically underdeveloped nation has given birth to a plethora of bed-and-breakfast's and restaurants that satisfy a westerner's taste buds, however, this happened after restaurants catering for the locals came in, ironically. Families were and are still not too used to eating outside the home. So, it wasn't easy for me to find local food with a local taste at a local cost. Even the packaged foods, most, if not all of them, are imported from Thailand. People say that the more north you go, the more products from China and Vietnam you will find. But basically, there are only a few mass-produced goods (not to miss the famous Beer Lao!) packaged on Lao soil. What I personally liked the most was the Khao Soi (different from the Thai cuisine with the same name) I found being served at a 'street picnic table' right beside the Mekong. I even went for a second on the following day.

Mae Sot and Route 105.

In the northwest of Thailand on the Moei River border with Burma lies the small town of Mae Sot, the westernmost town of Tak province. The town is not only interesting for being a trade post between Burma and Thailand, but also for its diverse ethnicity: Thai, Burmese, Karen, Rohingya, Karreni, Mon, Kachin, and many other minority groups from across the river. Take a stroll in the market and you will notice that Thai is not necessary the major language spoken here. Due to the ongoing conflict between the Burmese military junta and the many ethnic minorities that inhabit the land along the border with Thailand, thousands have crossed the river and settled in villages and refugee camps along the border near Mae Sot.

A Muslim community is also present in Mae Sot, together with a mosque. One of my good old Thai friends lives in Mae Sot and she and her husband took me to a small cafe on a corner near the mosque. They make rot-tii-oo and tea at this place which seems to have become a pleasant get-together place for the locals to chit-chat during the early hours. Rarely will people be able to find any rot-tii-oo left after 10AM.

As of 2006, Tak province is home to 480,000, of which 150,000 are originally from outside the nation. And of that, approximately 80,000 are refugees that have either been registered or in the process of being so. Those who have managed to cross the border, most of whom are undocumented, have found shelter in border villages and refugee camps set up by the UN or other NGOs. And many of those who are not registered as a refugee work in the many factories near Mae Sot on a very low pay scale, though much better than in the land they came from. Meanwhile, Burma's population stands at around 47 million, of which Karens account for 7 million, the largest 'minority' group. Well over 600,000 have been displaced in camps within their country.

Naturally, Mae Sot is also the 'hub' for the many NGOs that work along the border to assist the endless number of refugees. Among them is a health care post called Mae Tao Clinic (MTC). Set up in 1989 by Dr. Cynthia Maung, herself a Karen who fled from Burma after the crushing of the '8888 Uprising' by the military regime, the clinic caters for those who travel across the border in seek of medical assistance, since there is none, if any, accessible, affordable health care available in Karen state (around 0.5% of the GDP is spent on health care), and for those who have already settled on the Thai side, but could not access health care because they are undocumented immigrants or simply for the lack of money. I met a lady who had walked for over a month from near Yangon, where she lost all of her family members in the deadly cyclone Nargis. She was suffering from PTSD (post-traumatic stress disorder).

Staffed with 530, of which 260 are health care professionals, and many of whom themselves are originally from across the border, the clinic is visited by approximately 400 every day, totaling over 120,000 patients per year. Although now well-known and attracting donations from all over the globe, the budget still remains extremely tight with an ever-increasing number of patients and a lot of issues have yet to be solved. Its in-patient facilities are still infection-prone, especially to the likes of tuberculosis, and more and more refugees give birth here, meaning more and more stateless children.

About 90 kilometers north of Mae Sot on Route 105 lies the refugee camp of Mae La, the largest of them all, housing 37,000 registered refugees and no less than another 30,000 unregistered ones. Because Thailand is not a member of UN's Convention Relating to the Status of Refugees, a person who wishes to be registered needs to be approved by both the UNHCR (UN Refugee Agency) and the Thai Ministry of Interior. With temples, churches, mosques, graveyards, schools, libraries, markets, and even a university, Mae La is like a huge refugee 'city', and so surprisingly, life here is not the worst for those who are registered, since they are eligible to receive food aid as well as space for housing, at no cost. Bored with nothing to do but unable to leave the camp nor return to their mother land, many couples fill the time to make babies, and family planning has become a seriously important topic. Others apply to live in a third country, while a handful work for the NGOs within the camp.

I visited one of Shanti Volunteer Association's (SVA) libraries, where children were forgetting their darker days and enjoying the time for learning. However, a boy who seemed unable to join the flock caught my attention. According to the staff, he had only arrived a couple of weeks ago, but just received the news that his father, who was also on the way, was killed in a fighting between Burmese government troops, the Democratic Karen Buddhist Army (DKBA), and the Karen National Liberation Army (KNLA), the military arm of the Karen National Union (KNU), which has been fighting for independence of the Karen state (in their words Kawthoolei). Whether or not that news was true is unsure, however, the extensive 'underground' information network of the people cannot be underestimated. And, the Thai cellphone can be used near the border even if it's on the Burmese side, as well.

Those who have been caught by the Burmese military or the DKBA have reportedly been forced to hard labor or simply 'used' as human walls in the event of fighting. In June, DKBA troops raided a Karen school, forcing students to flee to the jungle. 89 of them managed to reach Thai soil, however, nine of them caught malaria on the way in this naturally high-risk area for this fatal mosquito-borne disease. In the same month, near the Thai village of Mae Salit Luang landed four mortar shells launched from the Burmese side, prompting the Thais to increase border security. On June 15, the KNLA headquarters in Manerplaw fell to the Burmese army, and in May-June alone, no less than another 4,000 crossed the border.

'Chronic emergency' is the term many use to describe this region's volatile situation, which has not improved, or only deteriorated, since the conflict broke out in 1949.

A visit to Ban Rong Ta Tee.

During August 10-12, 2007, which is already over a year ago, the "Intergration of Health and Social Development: Thailand's Experience" program run by Mahidol University's ASEAN Institute for Health Development (AIHD) took us to Ban Rong Ta Tee, a village located in the northern part of Lan Sank District, Uthai Thani Province, in central Thailand. We would be home-staying in that village with the respective families for three days and two nights, carry out a small research by interviewing the villagers about what we wanted to know about, and come up with some kind of conclusion to present. Never did I think that that experience would have a tremendous impact on the way I see things...

Dr. Chokrachan Chairoeksuksan, a family medicine physician at Lan Sak Hospital, gave us an overview of how health care is provided in this rural area, in its most effective and efficient way possible. Lan Sak District is divided into six sub-districts (tambol), which in turn are made up of 84 villages. Primary medical care is taken care of at the 'primary care level', which is the local public health center, 10 of which are spread throughout the district. If the medical issue could not be solved there, the patient would be referred to the 'secondary care level', which is in this case Lan Sak Hospital. If further specialized care is necessary, that is the responsibility of the 'tertiary care level', which is in this case Uthai Thani Hospital, the largest public health care facility in the province.

The public health center in Ban Rong Ta Tee community is one of 10 in the district and serves 5,263 people and 1,122 households. There are 104 health volunteers working in the villages and they play a key role in promoting health. Those who tend to act as leaders in their neighborhood, are more conscious about health, and are willing to receive some essential medical care training, would be a good candidate for a health volunteer. They would be responsible for connecting the villagers and the health center, including taking patients there when they need the help or gathering villagers to the health center for health promotion activities. There are no physicians at the health center and just five people (manager, community health worker, nurse, nurse's aid, janitor) run the center. The mobile physician team comes here once a month. I became good friends with the nurse, Wanrob Klomlit, who everyone calls Rob, maybe partly because he's the same age as I am.

Now, when we carried out our interviews in the village, our group decided to ask questions about the number of members in the household, their jobs, income, food habits and change over years (if any), their favorite foods, past medical history, smoking and drinking habits, education received, and what they would do in case of an illness. It was really interesting. Truly. Although each household was different, household after household, we started to get the bigger picture of the village. What kind of people live here? What are the strengths of the people? What are the weaknesses or the issues that underlie? What can be done by themselves to overcome those issues?

So our group's research theme was this: the effect of lifestyle change on the community. We focused on the villagers' lifestyles, especially food habits and health care habits. And as we carried out are interviews of the villagers household by household, we realized that between generations, there lay some differences. So, to have a better glimpse and understanding, we decided to categorize the villagers into three generations; the first of which we defined as 50 years old and over, no-longer-working-in-Bangkok generation, the second would be 30-49 years old and the working-in-Bangkok generation, and the third is defined as up to 29 years old, the young workers and the children. Here, when I mention "working in Bangkok or not", I mean by the phenomenon where the working age group are increasingly getting jobs in the huge bustling capital of this kingdom, instead of working in their local hometown villages. So when visiting a household, it was not uncommon for us to see a family of grandparents living with their grandsons. Their parents? Down in Bangkok, or Krung-tehp, as the Thais call the capital.

Generally comparing the generations, we found out that basically everyone eats and likes the traditional Thai food, such as the som-tum (papaya salad), kao-man-gai (boiled chicken on rice), seafood, etc, but we found out that the third generation likes western fast food as well or even more, such as pizza, french fries (chips), or candy bars. Younger people like to drink beverages such as coke too and consume more fried food. In terms of health care, there were almost none who did not believe in contemporary medicine. Everyone had good relations with the health center and would generally accept any kind of general treatment, whether western or oriental/traditional medicine. In Thailand, herbal medicine is officially recognized by the public and the government. Some elderly still relied on things such as ointment made by themselves from resin or herbal fruits that are not seen in health care facilities, but after all, if they have been living with it for decades and they're happy with them, and don't have health issues, why tell them to stop.

All in all, we saw two major issues in the community. A risk of lifestyle-related diseases akin to those now a problem in western countries, among the second and third generations is the first. Many in the second group already had past histories of hypertension, high cholesterol, diabetes, cancer, etc. The second is, with more and more younger generations going to Bangkok and deciding to live their for a long term, the village population is aging, which could lead to decreased livelihood or even the collapse of the community in the end.

However, there were certain strengths as well. The smoking and drinking population is not so large (Buddhism and monks have a big effect), they have a good environment with lots of nature, clean air, no traffic jams, and a relatively stress-free life, especially when compared to Bangkok. And even if many of the second generation move down there, there are still some that choose to remain in the village, and with the Thai tendency to regard their parents and families highly, those in Bangkok are unlikely to stay there forever, at least for now. Many village homes are centered around the health center and the adjacently-located primary school (elementary school), and the relationship between the health center staff and the villagers is good. They know each other well and the villagers feel easy about visiting, thanks partly or largely to the health volunteers.

Rong Ta Tee Health Center has a variety of health promotion activities such as the mosquito project (over 92% of homes now use measures to keep mosquitoes out of their water), aerobic exercise on weekends, elderly persons' education for self-help, breast and cervical cancer prevention, diabetes and hypertension project, HIV/AIDS project, increasing well-being project, developing exercise leaders project, and promoting good health among the elderly project. Now, we felt that they should now put more effort in aiming some projects at the first generation, the young. They should take advantage of the proximal location. Also, they should start thinking of ways to re-develop the community by means of creating new values, such as community-oriented small businesses. Doing this with existing resources both material-wise and manpower-wise would be a key.

But so, how did all this have a 'tremendous' impact on the way I see things? Well, I guess I learned two big things. One is that, the economical power of a community does not necessarily reflect the quality of life (QOL) of its people. In other words, it doesn't mean that if a family is not financially rich, they are not happy, and vice versa. Whether it's those living in Bangkok, Tokyo, or London living a daily life in the bustling streets full of stress, do all of them look like they are living a happy life? Through the interviews, I truly felt that many families in the community are living a happy life, in spite of some of their economic status being not so high at all compared to the average Thai. Happiness and economic development: they're not unrelated, but they don't necessarily come together. The other thing I learned is how much a people can get things done together themselves with minimal top-down type professional aid. With the health volunteers playing an important role, many villagers knew how to take care of themselves, and knew what needs to be done and who to go to in the event of a health problem. There were lots of on-going community involvement activities that are facilitated by the people.

Community-oriented, people-centered health care through community organizing and building, unlike those hospital-oriented, physician-centered medical care seen in economically developed regions. That is a critical part of primary health care (PHC), as the WHO said together with UNICEF at the Alma-Ata conference back in 1978. Health care for the people by the people... there are lots Japan and the western communities should learn. :-)

A visit to Wat Phra Baht Nam Phu.

Last summer, on August 8th, I had an opportunity to stop by the Wat Phra Baht Nam Phu, which translates to 'the temple of Buddha's footprints'.

At least one million Thais have been infected with HIV/AIDS since the first reported case in 1984. The rate was increasing at an alarming rate in the 1990s, however, with the society at that time not well aware of what was becoming a major social issue, those affected were cast aside and left to die. Situated in Lop Buri province, 120 kilometers north of Bangkok in central Thailand, the temple was turned into what it is now, an AIDS hospice, by a Buddhist monk named Alongkot Dikkapanyo back in 1992. Since then, the facility has expanded to accommodate 400 beds from an initial number of eight, thanks to the temple's extensive public relations strategies bringing in donations amounting to the equivalent of millions of dollars. Photos of the temple’s sick and emaciated patients adorn posters and donation boxes across the nation and television stations from around the globe visit to film documentaries. Wat Phra Baht Nam Phu is currently home to over 200 HIV-infected adults, and has been for a number totalling 10,000 over the past, most of whom died from the illness.

The temple's activities have always been controversial in recent years. Tourists from mostly western nations visit in thousands every week, taking tours that are guided by some of the relatively-healthy AIDS patients. They go through the wards where the relatively-weak AIDS patients are, without much explanation, and continue on to the 'Life Museum', a collection of dozens of mummified corpses of dead AIDS patients, who according to the staff, agreed to be put on exhibition prior to their death. That is followed by the crematorium, which is surrounded by what seem to look like sculptures or other pieces of art made from the bones and ashes of those who have been cremated here. Then they walk to a hall which houses a Buddha surrounded by piles of sandbags, or 'ash-bags', which contain the ashes of those who were cremated but have not yet found relatives to take it home. Visitors also have an opportunity to see a dance show done by AIDS patients too. And after all that, they leave behind tons of donations.

Yes, the hospice provides care and 'protects' those suffering from AIDS, but what is it doing to how people see HIV/AIDS patients? Dead AIDS patients whose bodies are not taken back by their relatives become sandbags or pieces of art, or part of the exhibits in the museum that has little explanation of the bodies. Those who are weak, and in their twilight of their lives, simply lie on the bed as tourists pass by giving them that look in the eye. You can often see the visitors covering their mouth upon entering the ward, then swiftly moving through wordlessly. Many don't even say hello. Those who are still relatively healthy host the tours or performances for the visitors, helping to attract more donations. I can't help myself from feeling that all of these together only exacerbate prejudice.

In Thailand, more than 400,000 have died from AIDS, however, it is also one of the few countries to have successfully curbed its epidemic with awareness campaigns, and later pioneered the widespread distribution of anti-retrovirus drugs (ARVs), which slow the progress of the incurable disease. In the 1990s, up to 100 patients died at the temple every month, but now, that number has been reduced to about 10. According to UNAIDS, fewer than 17,000 infections were reported in the country in 2006, compared with 143,000 in 1990, but officials are worried that the rate could climb again. HIV prevalence among intravenous drug users and sex workers remains high, while condom use among Thai teenagers is shockingly low. No time should be spared to come up with a new way to spread awareness.

In Thailand, generally speaking, monks are highly respected. Much more than the government, to be sarcastic. I believe that when it comes to bringing social awareness, they have a vital role to play. :-)

A visit to RTIC and Ta Nao Si Health Center.

On March 27th, I was able to visit Rajanagarindra Tropical Disease International Centre (RTIC) and Ta Nao Si Health Center, in Suan Phueng district, Ratchaburi province, near Thailand's western border with Burma (Myanmar).

How did it happen? Well, a very good old friend of mine from my high school days in Maryland, U.S. took me there. He was one of my best friends there, but an year after I returned to Japan he also needed to go back to his home country, Thailand, and as our lives got busier, our emails became sporadic. However, as our lives progressed, so did information technology, and one day he invited me to Facebook, a social networking service (SNS) which is especially popular among university students in the U.S. with well over 85% of them being members. We've been in close touch ever since, and I had a chance to see him this spring for the first time in nine years.

He majored in public health and epidemiology in university, and as that implies, shares a lot of common interests with me. We could go on talking for hours and hours, until our tongues became numb. And... he is also a humanitarian junkie. He's a highly-motivated, passionate, yet kind and thoughtful person who always used to talk about how he wanted to do good for his country and its people. So well, when I asked him if I could take a peek at some places he know that can be visited during my time frame there, he happily offered me to take me here.

RTIC, or the Suan Phueng Research Unit, run by Mahidol University's Faculty of Tropical Medicine and supported by the Tropical Disease Trust Fund under the Princess Galyani Vadhana, is one of the faculty's research stations for conducting research on tropical diseases. The facility's primary activities are (1) provision of health services (especially against infectious diseases) for the local people, (2) field epidemiology training for students from not only the faculty but from other countries as well, including Cambodia, Vietnam, Laos, and Burma, and (3) research of infectious diseases (mainly malaria) in the area.

Suan Phueng is a small district in Ratchaburi Province, located on the border with Burma, which is just a 15-minute drive from RTIC. It has an area of 2,545 square kilometers, consists of seven sub-districts with 8,254 households and a population of 66,972. Over 90% of the population are mainly Thai-Karen of low socio-economic status, some of who do not carry Thai identity cards. Along with 13 health centers, they also have a community hospital with 30 beds, about 30 minutes from RTIC. Common health issues of the people living in this area include malaria, dengue hemorrhagic fever (DHF), filariasis, tropical skin diseases, intestinal helminthiasis, and malnutrition.

When we visited, Dr. Maneeboonyang of Mahidol University was on duty at RTIC and he happily welcomed us and gave a brief tour of the center. According to him, this area has the highest prevalence of malaria in Thailand at around 12-13%. The kingdom is one of only a handful of countries that have succeeded in eliminating and controlling this notorious mosquito-borne disease, however, it still remains a big issue along the border with Burma. But still, the situation has been improving, since prevalence was around 30% only a decade ago, with at least one person in every single household having malaria in one of the hamlets. According to Dr. Maneeboonyang, RTIC sees 10 patients per day in the dry season (January - April) and over 30 during the rainy season, and out of that, about two and six people are diagnosed with malaria, respectively.

After the tour, he was kind enough to take us to Ta Nao Si Health Center, which is one of 13 health centers in Suan Phueng district. It provides primary medical care, immunization, and antenatal care for the local residents. We had a chance to have a short talk with the public health officer there, and according to him, the top three common diseases in the village are malaria, diarrhea, and flu, though hypertension (high blood pressure) and diabetes are becoming a problem especially among the elderly.

At the end, we had an opportunity to drive around the village to see some homes of the Thai-Karen, which look different from the traditional Thai examples. It was not long before the sun was starting to set and so we had to leave the area (local roads are without pavement and lights), but the staff at RTIC were kind enough to offer me to visit again, next time staying for a few days. And there is also Tak province, sometimes called the "humanitarian aid mecca of Thailand", and the Thai-Burma border area there, about an eight-hour drive from Bangkok. I definitely have to and sure will come back again.

Many thanks to my friend. :-)

Looking back at 2007.

Time flies.

Oh boy, I wonder how many times I've said this phrase on this blog. But well, it's true. But it's also true that this year was full of meeting new friends and discovering my interests... and myself.

In spring, I participated in VIA's (a non-profit based in San Francisco and on the Stanford University campus) Exploring Health Care program to learn about health care in the USA and in the Bay Area in general. Along with medical students and undergraduates thinking of going that way, we hopped around the area to see hospitals, clinics (both private and free), homeless shelters, shadow doctors' rounds, participate in class to get a taste of what medical education is like there, and much much more over a period of 2 weeks.

The gay clinic called the Magnet, located in the heart of Castro, the gay mecca of the country, is what sparked me into community-based health care, or in other words health care that involves the entire community. What's amazing is that it's not merely a clinic but has the potential to act as a catalyst to bring a people together and empower them as a whole. I'll talk about this much more in detail another time...

And this summer, I found myself in a 11-day primary health care (PHC) training program at Mahidol University's ASEAN Institute for Health Development (AIHD) in Thailand. Along with nursing school students from that country, we followed a highly-concentrated course to see health care in the urban areas of Bangkok (including the slums), go up 4 hours by bus to the rural areas in Uthai Thani Province and stay in a village to do some epidemiology field work 'for beginners', and do a presentation at the end with our groups.

The rural area home-stay and the interviews and other interactions with the villagers totally changed how I think, and this is where PHC and community-based health care got on me. Again, I have to save another time to tell this in detail...

And last but not least, DOCS (acronym for Development of Clinical Skills), which we formed with the former participants of the Exploring Health Care program in our university to get a head start and practice clinical skills, played an important role in my life this year. We found energetic, passionate, student-caring doctors who were willing to teach us, in a university where we once felt finding those kind of mentors was devastating. Moreover, the activities led me to knowing general medicine, family medicine, and primary medical care, which then led me to Ukima Clinic, a community-based clinic up in northern Tokyo. (See post 2007/11/20.)

The more I look back at this year, the more the activities I was involved in get connected in one straight line. Compared to a year ago, I couldn't have imagined myself where I am now. This year helped me discover what my true interests are in (at least for now), and now I can much better describe the bigger picture of the doctor I have in mind for my future.

Wishing everyone a happy holiday season and another great year! :-)

AIHD 2007 reunites in October.

I really like these people.

And I think these people truly like each other. Almost three months have passed since the Primary Health Care (PHC) program at the ASEAN Institute for Health Development (AIHD) at Mahidol University, Thailand in August, but we're still close together. We're holding dinners and parties at least once a month, and the members just keep on coming. The October dinner was held on the 23rd, and one came from Nagoya by shinkansen, another came from Fukuoka, 900 km from Tokyo, just for the event. Two others dropped by at 10PM after finishing work and training, respectively, just to have a few moments to see who's here and what's up with them.

Just amazing. I wonder what got us so hooked up with each other... and no doubt I'm one of them. We had 37 Japanese in the flock in Thailand, and of course, not all of us come to join these events, but every time we get together, there's at least a dozen members, and what's both surprising and amazing, is that that number keeps on going up time after time.

And, we're all with different backgrounds. Not only are we comprised of medical or nursing students, but also people who already work, either in the medical field or somewhere else, or students from totally different areas of study (at one glance different, but actually connected). But there's some kind of intrinsic common factor that's keeping us together... :-)

Two months since Thailand's experience.

Time flies.

Already almost 2 months are about to pass since I participated in a primary health care program at the ASEAN Institute for Health Development (AIHD) in Thailand. The facility is on Mahidol University's Nakhon-Pathom campus.

When the program was over, my heart was filled with something... a strong passion, a strong will to do something. Of course, the program had a big impact on me, and that impact will probably be as big as making changes in my life in a very positive sense... but I'm not sure whether this was the direct reason for me feeling that strong something. It also kind of felt as if I were rushing.

Maybe I was too excited during the program that I wasn't able to "switch" that mode back to reality even after being pulled back into my everyday world? I came up with new ideas that I may want to try, and maybe I got too excited about them? Or, maybe I felt frustrated that I still didn't have the capability to start turning those into reality? After all, I'm still a university student, without profession nor money. Maybe all of these reasons?

It's like this... I had this liter of fuel in me, and I continued to burn it through the program, but the more I burned it, the more I was refueled. But after the program was over, all of a sudden, I was left with all this fuel but nothing to burn it for. It's like you all of a sudden have a big empty space.

I made really good friends during the program too. Maybe I just simply felt sad that itwas time to say good bye for now? The program itself ran for only 11 days, but by the time it was over, I felt as if I had known these participants for months, or even years. I had the opportunity to do some really deep, interesting, and stimulating talks with some of them. Those friends might turn out to be really close partners in the future, maybe some of them even closer than now.

Well, am I still excited? Yeah... of course. Why not? But, I have to be cool-headed, think ahead, and plan out things carefully. While there are things I can do for the society now, now's a time for me to put building my profession at the top of my to-do list. I need to and want to invest time in the future now. Meanwhile, I'd like to look back and share how the program had such a big impact on me, and may have on my future... maybe on another day.

Ah... how I enjoyed talking over those bottles of Singha... "Chai-yo" :-)