Blog and life revived

Wow, time flies. I am not sure why I got away from updating this blog. My life has continued at a manageable pace and I have done plenty of interesting things since September, but unfortuneatly I did not document them. This saddens me because as I reread my prior posts, I am reminded of forgotten tidbits. Of course, I still remember the big things, but it is nice to have some of the little things written down for review. While some folks may find it interesting at times, this blog is really for me.

So what have I been up to in the last 6 months? Among other things, a whole lot of bicycling. In September, I wrote about my new bicycle and 25-40 km rides that left me tired and with an aching back. Things have certainly changed since then. I don’t know for sure, but I estimate I have ridden somewhere around 2500-3000 km in the last 6 months, including an amazing nearly 400 km adventure through the mountains from Vientiane to Xieng Khouang/Phonesavanh. Even though I didn’t blog about it, this trip is something I will always remember. All this cycling was spurred on by the challenge of an endurance ride, the idea of which leaves most people thinking you are crazy. When I started, I had no idea it was going to end up being such a lifeline for me. Despite the daily frustrations of my work here and occasional periods of restlessness, my exercise keeps me sane. Through cycling, I have become acquainted with a group of people who help motivate me to get out of bed and get my rear moving. They notice if I don’t show up and encourage me to keep at it. It is also nice to interact with people who don’t work in a hospital and who can talk about a whole variety of subjects while cycling through the countryside. With the encouragement of these folks, I have also started to get back into swimming and have started running. I had forgotten how much I enjoy swimming and it is fun to reminisce about my swimming days while backstroking and gazing at a beautifully blue sky. Running is still a difficult mind game, but it is getting easier and I think I am about to breakthrough to the point where it is enjoyable. The next challenge on the horizon is an Olympic distance triathlon. I plan to be able to say I am triathlete before I return to the US.

My physical fitness is much better than it has been in years. My weight has only slowly creeped down but my clothes are looser and my Lao colleagues want to know what I have done to get so ‘joy’ (thin). When I first arrived in Lao, my weight was a frequent topic of conservation, with repeated reminders of being ‘dtui’ (fat). Now, my weight is an even more frequent topic of conversation, but in a way that is less painful. I frequently hear my residents talking in Lao about my weight or appearance while I am lecturing, not realizing that I understand quite a bit of Lao these days. It still hurts some when Lao colleagues make hand gestures to indicate how big I was before and ridicule someone else for being ‘even bigger than Christine’ but at least they are no longer discussing my death by heart attack. My housekeeper told me a few months ago that I was beautiful. It would have been nice if she’d stopped there, but she continued “When you first came to Lao, you weren’t beautiful, but now you are.” Last week, the head of pediatrics stopped me at a workshop to ask my secret and wanted to know my daily diet. Funny how people think folks who are successful in losing weight must have a secret we are not sharing with the rest of the world. My “secret” of lots of exercise and making better food choices doesn’t seem to be what they want to hear. If I had a magic bullet, I’m not sure I’d be hiding it in Laos. It is a slow process, but I’ll keep chugging away.

Exhausted and worse for wear, but on top of the world--or at least the dratted mountain.

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.