Patuxay

So after living in Vientiane for over a year, I decided today it was time to visit one of the most prominent tourist sites in Vientiane. The Patuxay is the Victory Gate of Laos and was constructed in 1962. The story goes that the US government donated concrete to Laos to build a runway. No runway was built and this Arc de Triumph-like structure appeared. It is hence known as the world's tallest vertical runway. Now it stands at one end of Vientiane's Champs-Elysées with the presidential palace at the other. For about 40 cents, you can climb to the top and visit souvenir shops along the way. Interestingly, I was one of the few foreigners there and I was surrounded by enthusiastic Lao visitors. I particularly like the sign on the wall with a less than flattering description that seems to have been copied directly from a guide book. Ah, monster of concrete.

More bicycling adventures

So, after the adventure I wrote about in my last post, I decided it was time to invest in a proper bicycle. My colleague and I are planning to do a fund raising ride from Vientiane to Luang Prabang (388 mountainous kilometers in 3 days) which will certainly require more than one gear. So after a day of shopping we settled on matching Thai bicycles. The first day out, we took the same route as my flat tire adventure. I happily waved at the tire repair shop as we zoomed by. It was a nice ride, but my back was sore and I couldn't feel the 4th and 5th fingers of either hand for the next four days. I returned to the bicycle store for new handlebar grips and gloves and the numbness has been much less on subsequent rides. I have ridden a different 25 km loop a couple times and am really enjoying the new bicycle.

So, this morning, Amy and I set out on a different route. About 5 km in to the ride, the road became exceedingly potholed and it was a challenge to dodge the mudpuddles, potholes and motorcycles along the way. It was so bumpy that Amy's water bottle holder jiggled off and landed in the middle of street denting her bottle. We then came across a fork in the road. We asked another foreign rider which way to go if we wanted to ride along the river. She said go right. As we approached the fork, it looked pretty clear that we should go left, but we decided to explore. After another jostling kilometer or so, we did come to the river. The road curved to follow the path and I thought it would be a nice quiet ride along the shores of the Mekong. The road did not go far, though, before curving again and winding us through a village before tapering off into a muddy mess and ending in a cow pasture. Being an optimist, I hoped it would just keep on going and join up with the other road so we kept riding through the mud and hoped the cows wouldn't mind. With the trail becoming fainter and now covered in mud, we decided it was time to turn around. I was happy to reach the packed dirt path again and it was actually nicer than the potholed pavement. I must have been quite the site as multiple motorcycles full of people laughed and pointed as they drove by. With well jostled bottoms, we decided to head for home where we had to give our bicycles a bath to return them to their blue color. I then enjoyed my own shower to return me to my usual pale hue. Ahh, it was great. Where will our next cycling adventure take us?

Sunday afternoon adventure

It was a beautiful, relatively cool day today so I decided to set out on a bicycle ride. I have been planning to buy a proper bicycle that has more than one speed as opposed to the Chinese specials which have been in the HF fleet for many years. They work just fine for getting around town, but I would like a new bicycle for longer rides. I have been hesitant to spend the money to get a proper bike because I wasn't sure I would really use it. So this afternoon, I decided to go for a longer ride and see if I am really interested in doing more riding.

I had a great ride from Vientiane to the Friendship bridge 17 km away. Traffic was light on Sunday afternoon and the sun was warm but not punishing. Being rainy season, the fields were a lush green and I enjoyed seeing the people enjoying their Sunday afternoon. I went a couple kilometers past the bridge until I found a shady spot on the Mekong where I could drink my water and gaze at the Thai landscape on the other side. It always amazes me to ponder how different life is on either side of this river. Two countries so close together but worlds apart.

After rehydrating and stopping to photograph the cows grazing in the post office yard, I set off on my 20 km trek back home. The sun was much less intense and I leisurely stopped to photograph the lush scenery and the Pepsi bottles guarding the entrance to the Pepsi factory. I was cruising along, when I heard a new noise which sadly did not fade with the passing car. Realizing that I had a flat tire, I stopped and started walking toward a nearby repair shop. Thankfully, repair shops are relatively ubiquitous in this land with lots of poorly constructed motorcycles.

At the repair shop, I was greeted by three men. Two of whom began working on my bicycle to assess the problem. The third reeked of alcohol and started talking to me non-stop in Lao language. I repeatedly told him that I only speak a little Lao and that I didn't understand most of what he was saying. He was undeterred, however, and kept rattling off. I tried to be show polite disinterest, but he persisted. My Lao language skills are enough to know that he was expressing his love to me and was pointing out the difference in our skin color. He repeatedly bowed to me and seemed to think I would be more responsive if he put his face two inches from mine and touched me intermittently. At one point he took to hitting me on the head. The guys who were working on my bicycle told him to leave me alone, but they weren't very insistent and he continued. I amusedly watched the repair of my bicycle hopeful that I could get away from this intoxicated man soon. At first, I chuckled when the patched tube popped when filled with air.

Unfortunately, my laughter disappeared as the repair of my bicycle drug on and I became increasingly annoyed with the drunk man. The men repairing my tire had been drinking, too, but were much less drunk than Mr. Obnoxious. Sadly, however, I think their mechanical skills were impaired. After taking an excessively long time putting the new tube in, they said I was ready to go. Much relieved, I happily paid and was ready to finish my afternoon ride. Before mounting, however, I noted the brakes did not work. Back for more tinkering. With that fixed, I jumped on to ride away, but then the chain fell off. Back to the shop with its wheels up. Somehow in the process of putting the chain back on, the new tire totally split down the seam. One man headed off on a motorcycle to find another new tube, but returned empty handed. In the mean time, drunk man had gone back to his preivous antics. An hour and a half later and with the sun heading toward the horizon, I decided that I wasn't going to get to finish my ride. They helped me hail a tuk-tuk and put my bicycle on top for the trip back to town. They did return the nice tip I had given them initially, but my tire still isn't repaired and I didn't get to finish my ride. Thankfully, though, the nice couple in the tuk-tuk was much more pleasant than the incessant yapping of the drunk man who blew smoke in my face and spilled his beer on me.

I love the Lao people, but I do not like this part of the culture. The abuse of alcohol is so pervasive and is considered an integral part of the culture. Alcohol is needed to have fun and there is little concern regarding the health or safety effects of excessive alcohol consumption. I don't even want to know the rates of drunk driving. It is pretty scary. When taking a social history about alcohol consumption, the residents always tell me he drinks "sometimes". When asked to clarify, the answer is "normal" or "when there is a party". From what I can tell "normal" is well beyond generally accepted levels for safe consumption. I wonder what the cost of this disease is in terms of loss of life and productivity.

Anyway, I'm glad to be home from my adventure. Given I have gone on two long bike rides and the bike has broken down both times, I think I will buy that new bike after all. The riding part was quite nice and I think it is an activity I would enjoy.

Power Tools

I recently decided to redo the bulletin boards in the entry of our office/house and try to make things look more tidy. I enlisted Ning to help me make sure things were centered and straight. Much to my amazement, she really got into the project. She loved to use the drill and I think she was disappointed when the last hole was finished. The years of helping my mother put up her bulletin boards at the start of the school year came in handy in cutting out the lettering. I moved the map and redid the pins with typed names and color codes to show our pediatrics and internal medicine graduates and current residents around the country. It is nice to see the coverage over the country. We will soon have pediatricians in every province in the country. It will be a little longer for IM, but we are making progress. This project was a nice addition to the office and often viewed by visitors.

Finished project (nearly--I still want to fix the pages for each class)

Graduation Reception

Christine with Class of 2009

My gang--love 'em

On June 5, Health Frontiers celebrated our 9th annual graduation reception. The class of 2009 is the 9th class of pediatricians and 5th class of internal medicine physicians to complete the program. The event was held at the US Ambassador's residence and was a great time of celebration for the Lao physicians as well as the international health community in Vientiane. The residents still have to defend their senior projects this week, but hopefully we will soon have 8 new pediatricans and 6 internists to help the people of Laos. The actual graduation ceremony with presentation of diplomas will likely be in August.

Vang Vieng adventure

Around the time of the G20 summit, I set out on an outing with our own little G5 to Vang Vieng. With five people from five leading Western nations (Germany, England, France, Australia, USA) exploring in Laos, it was bound to be a cultural experience. The first day we set out from our guesthouse in kayaks. The water level was low, but we were the only ones out and it was quite beautiful and peaceful. As I had not really kayaked before, I partnered with Bertrand from France in the one double kayak while the other three set out in single kayaks. Things were going quite well, until we came to a small rapid with low water levels. Bertrand and I ended up hitting the bottom and eventually capsizing. After expending significant effort to retrieve our boat and empty it of water, I moved to a single kayak and let some other folks try the double. Wise decision on my part, as that double kayak had suffered an injury and began taking on water. The hole grew as did the water problem in the craft. We made it a couple kilometers further downstream before watching the duo in at the time sink suddenly to the bottom of the river. We were reluctantly forced to abandon the double kayak at a guesthouse along the river. The five of us then set out in the remaining three single kayaks--I therefore took to swimming. It would have been fine, except the water level was so low that crossing the rapids in the current was a bumpy, painful experience. As we entered the area where the backpacker crowd was having their drunken, drugged fun, we just watched in fascination. It is amazing that more people don't get injured there than do as it looks like pure stupidity. As evening was approaching, we paddled and swam toward town, but it turned out to be further than we anticipated. The swimmers were getting cold and tired and eventually we hired a boat to take some folks into town. Irwin and I continued paddling. As dusk turned to dark, we had still not arrived at the town and I was thinking new thoughts about stupidity. Irwin and I were quite thankful to see the lights of town and were more than happy to climb out on shore. I think we all slept soundly that night.

The next day we set out on a trek to a cave where there were reportedly rock climbing routes. This turned out to be another adventure as we came across a very, very rickety bridge across the river with not enough bamboo to reliably hold up under a person's weight. Several of us ended up fording the river which was its own adventure. After asking many locals, we finally came across the cave, but did not think it was the cave we were actually seeking. After a lot of pondering, we finally realized that we needed to walk through the 150 m long cave to get to the rocks on the other side of the mountain. As one member of our group was quite claustrophobic, she and I trekked over the mountain. It was a nice view from the top, but I would have much preferred the cool, much less strenuous tunneled route. I think we were all quite amazed when the overland travelers caught up with the tunnelers at the long sought climbing routes. The fried rice our guesthouse owner had prepared for our lunch was very welcomed, even if it did leave its grease all over several of the backpacks. I watched the climbers do their thing and then we set out in reverse. We all went back through the cave and traversed with locals who led the way with their flaming torches. It was quite an experience. We all forded the river on the way back, but this time, I slipped and end up walking back in a very wet state. Again, we were quite relieved to make it back to the guesthouse, but it was that good kind of tired after a wonderful adventure.

Bowling Fun

Part of the bowling crew. Dr. Veokham throws the first bowling ball of his lifetime while Dr. Sisomphone looks on in her bowling skirt.

There was a fair amount of anxiety in the air in April as the end of the academic year was drawing near. The current residents were anxious about their final exam; the new residents are anxious about orientation and starting the program; and I was anxious as to whether any of it would actually happen. Thankfully, however, things seemed to have gone well and we are set to begin a new academic year on a positive note. To celebrate, I decided we should turn Thursday night lecture into a bowling extravaganza. It was a great night of laughter and cheer. For most, it was the first time they had ever bowled and the different bowling styles were quite amusing. It was good to see everyone having a good time and experience something new. They all seemed to be truly appreciative of the outing and I think it was money well spent, even if some of the first-timers did out bowl me

And, yes I did give it a try myself.
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Queens Day Football Tournament

Australia vs. Multinational Team


Netherlands vs. England


Sweden vs. Vientiane International

One of the things I enjoy about living in Vientiane is the interaction with the expatriate community. People from a wide variety of countries live and work together and I enjoy learning more about their countries and cultures through them. My knowledge of Australia has increased significantly through my interactions with friends here as well as listening to the Australian Broadcasting Channel. Like today is Anzac Day in Australia and New Zealand to honor war veterans. Today, I was asked to help with the first aid tent at the Dutch Queen's Day football tournament held at the Vientiane International School. Teams from the Netherlands, Sweden, France, England, Australia and a hodge-podge interanational team took on a few local Lao teams. It was quite entertaining. Of course, the whole time I was hoping there would be no serious injuries since for all my medical training, I don't have a lot or practical skills for things like sports related injuries. Thankfully, I just had a few superficial abrasions to clean. I enjoyed watching the soccer and wonder why America doesn't adopt this sport. It just seems so much more entertaining, safer and requires less equipment than American footbal.

Lane Xang Bug

So I came out of my gate the other day to find the partner VW bug to the Lane Xang scooter. It certainly is eye catching, but I still strongly dislike the idea of advertising alcohol on motor vehicles.

Beer Lao Scooter

What is wrong with this picture? At the recent elephant festival, we found the Beer Lao booth promoting their special festival brand beer--Lane Xang (Million Elephants--name of the former Kingdom in what is present-day Laos). They were having a raffle and it looked like the grand prize was this Lane Xang Beer scooter. Alcohol plays a large role in the Lao culture and being unable to perform emergency surgery because you are drunk or driving while intoxicated is not shameful or unaccepted. During Jon and Rose's visit, Jon gave an excellent grand rounds about the physical and societal effects of alcohol including trauma, fetal alcohol syndrome and professionalism in the medical community. I have found myself in some uncomfortable and unsafe situations due to the lack of societal understanding of drunk driving. I once was riding with someone I thought had drank more than he should have and listened as he told me about his long time physician friend who had died in an alcohol-related crash that week. There seemed to be no understanding that this could happen to him (or innocent others), too.

I have noticed some signs around town placed by the Beer Lao company discussing responsible use of alcohol, but they are not wide-spread and I doubt they are effective. The government has a significant financial stake in Beer Lao which is a conflict for public health issues. The no smoking campaigns have taken off in the hospitals. We will see how long it takes for responsible use of alcohol to be aggressively promoted.

Reanimation Unit

Entrance to the adult intensive care unit at Mahosot hospital. Somehow I suspect the outcomes aren't as good as this sign makes it sound. Animation is a pretty complex task that is not easily re-done.

It's a bird; It's a plane; It's SuperMom!

I have to admit I was a little nervous about my mom coming to SE Asia for a month for her first real travel in the developing world. How would she do with the food, accomodations, heat, TOILETS? Well, I was very impressed with how well she did. It seemed that everywhere we went there were tall steps, hills, boats or other general obstacles and she did quite well. Other than the heat stroke I almost induced for her walking from the few blocks between the Grand Palace and Wat Pho in Bangkok, there were no major catastrophes. I think she is an adventure traveler at heart, but just didn't know it before. Way to go, Mom!