Wholehearted People

On a major descent, we stopped to look at this masked palm civet, which the ladies assured us would  make for a lovely lunch!

You get out in the mid-day sun, and you get faint.  Any effort pulls hard at your body’s ability to maintain equilibrium, and judgement fades quicker than an ice cube on a sun-scorched tarmac. Just minutes ago, on my way home from a local hash house, I passed a young guy walking down the street in shorts and flip-flops.  No shirt.  He was pulling greedily from a big bottle of cold beer Lao, the beads of condensation evident in my quick glance, his desperate sucking a nod to the elusive, pheasant-disappearing-in -the-bush quality that marks the heart and soul of beer Lao, and at this time of day, in mid-town Luang Prabang, that bottle’s soul was on the run.   Which makes my notion of a bicycle jaunt into the country of Northern Laos that much more perplexing. Sure! Good idea…get on a bicycle and peddle up ten degree inclines for like, oh, ten or fifteen kilometers…then race downhill trying to avoid trucks coming up and crowding your lane before hitting the next ten kilometer climb…all while studiously ignoring the residue of your brain pan as it boils out your ears.  It’ll be great! 

This being the downhill, I found it in me to smile.

My buddy Mike Costello remains one of my more trusted partners in crime.  Regardless of—or maybe because of—circumstances which would render the average bear less than enthusiastic to jump into whatever chaos I’m selling, Cos doubles down and makes the extra effort. Last year  I figured a ride down the Natchez Trace Parkway in mid March made sense.  Get out of the snow.  Springtime in the south.  And, amazingly, a number of buddies found ways to jump in and join me, which I certainly wouldn’t/couldn’t have anticipated.  But Cos has young kids; his life is hectic in ways I haven’t experienced for years.  Yet I was not at all surprised when he pulled off a last minute flight, shipped his bike, and met us in (?) Mississippi for a very cold, wet, miserable ride north. (Though, I hasten to add, rich in character-building qualities.)    

Cos on the way into town from the airport, not yet fully clued in on our adventure plans.

I assured him this would be different, if not the perfect opposite: we would enjoy hot and dry as opposed to wet and cold. The plan was simple: While Rebecca marched off to the Lao Friends Children’s Hospital to administer education and guidance to local staff in the hope of saving children from pain and hardship, we’d get on our bikes and ride around northern Laos.  Drink beer, stay wherever we could find beds, high five the village children while calling out sai bai dee as we sailed past their humble abodes. Never mind the fact that Cos had one week, and was coming from the winter land of Chicago all jet-lagged and bleary-eyed.  And, too, a little neck issue he confided the night before taking off.  “It’s at C6 and C7.  You aware of those?  I think it probably had to do with a tumble I took from the balcony of Alice’s Palace on Mackinac back in 1978. Remember that? Well I’m here to tell you, the transgressions of our youth add up and magnify over time, resulting in some potentially ugly shit. But I’m sure it’ll be fine.”  Uh huh.

I allowed myself a brief foray into the dark place of what if?  Like Cambodia and Myanmar, Laos is poor.  There are few medical facilities and fewer still  means of transport to said facilities, should the need arise.  In fact, if we had a serious crash or illness, probably the smart money would be an airplane ride to Bangkok, which happens to sport first class medical care. But one still needs get to an airport… 

“We could do something else.  There are options…”  This on the way to our boat Saturday morning.  In the streets of old town Luang Prabang, monks were lining up in their saffron robes for the morning alms ritual.  All seemed to be at peace—except for the lines of big white vans carrying Chinese tourists there to photograph this sacred act. We rode our bikes from Cos’s guesthouse to the boat dock, where we were scheduled to motor down the Mekong to the town a Pak Beng, an eight or nine hour journey west on that most storied river.  Our bikes and small duffels would be stowed in the luggage area near the pilot’s seat while we spread out on cushioned day beds and watched the river drift by.  At Pak Beng, everyone gets off to find a room, eat, and sleep.  Boats don’t transport at night, which when you see the jagged rocks in this part of the Mekong and the total lack of all things navigational, makes really good sense.  Typically, the passengers get back on the next day for another stretch of travel upstream toward Thailand, where most cross over for further adventures in Chiang Rai, Chiang Mai, the golden triangle, etc, etc.  But not us.

“We’ll see how it goes,”  Cos has this way of settling in to a plan and pushing things along through significant force of will.  And, truth told, I was looking forward to the boat ride.  Eight hours stuck on a boat can potentially suck, but we sprang for the luxury ride—Shampoo Cruises—which meant breakfast of croissants and good coffee, a traditional lunch, places to lay down, and not many other passengers.  Plus a toilet. But it was something of a one-way, no turning back endeavor; once in Pak Beng, we were committed to a four or five day ride that took us on three distinct legs for a total distance of 323 kilometers, culminating in our (hopefully) triumphant return to Luang Prabang. (Assuming, of course, we didn’t get bumped off the bikes and eaten by pigs.  Which could happen!  Though Laos drivers are among the most courteous of any I have ever encountered anywhere. I can’t speak with any authority on the appetites of the pigs.) 

On the Shampoo Cruise, enjoying the feel of God's fur-lined pocket

The boat ride was sweet.  Among other things, we passed an elephant actually pulling a pile of logs along the beach.  A bonafide working elephant!  I should say the elephant situation here is not pretty.  They get forced into tourist-carrying situations, in which they are yoked with heavy wooden seats and lumber along a set path with two or three passengers.  Not that hauling logs would be much better, but Rebecca assures me the benches cut into their hides—and there’s the indignity of it all.  Putting aside for the moment the fact that elephants are wild animals, there’s sound science pointing to extraordinary intelligence, including complex social interactions, capacity for empathy, and keen numerical skills—some research even suggests the ability to decipher differences in language. But we ride them because they are big.  Ok, so there’s plenty of big animals around here.  I don’t see people lining up to ride water buffaloes, yet the banks of the river were filthy with them.  If I were an elephant, I think I might need to crush some humanoids.)

I had secured lodging in Pak Beng for the two of us at a place that looked out over the river.  Cheap! (Though the city imposes a ten dollar tax per room, plus a three percent sales tax—something we did not find at play for the rest of our lodging adventures.) We walked the town, and both noticed an air not unlike that of a port city for cruise ships.  (Though seriously down market.)  Cos typically insisted we eat local fare, which suits me, and let it be here said we found the food for the whole of the trip fantastic.  Near as I can tell, neither of us have contracted any intestinal parasites, but rest assured if I start vomiting up pink worms, this blog will light up with sordid details.

We asked at the hotel about snagging a ride part way up the road, reasoning that it made sense to ease into things, seeing as how neither of us were in great biking shape.  The hotel dude wasn’t terribly optimistic, but said he’d put out feelers, and over dinner we decided we’d just ride north and hope for the best, should a ride not pan out.  Then lo! and behold! next morning the hotel owner hustled over to our breakfast table to tell us he’d learned of a guy needed to return his van to Oudomxay, who’d be happy to drop us midway for 350,000 kip ($42.00) Done. 

The first leg followed the Nam Beng river along a gentle upward-trending grade toward the mountains in the north.  We were let off at a little noodle shop about sixty or seventy kilometers shy of Oudomxay, and after a couple bowls of noodles and a quick shift into shorts and light shirts, were off.  

Here’s the thing about riding in Laos:  There are relatively peaceful stretches of farmland/hills/cement and brick factories, warehouses, etc., followed by villages, and sometimes towns.  But mostly villages.  And in said villages are three types of houses: Woven reed, wood board, and brick covered in concrete.  Think: Three Little Pigs.  And, as is invariably the case, the pig with all the money rules the day, which is to say, he who can afford a brick house.  Actually, you get a good sense of the relative affluence of a village by noting the distribution of reed vs. wood vs. brick dwellings.  Certainly the markings of relative wealth are found in all cultures, but it seems the growth of more substantial, solid dwellings indicates a move toward economic viability. 

Day’s end found us in the tarmac-laden town of Oudomxay (which goes by many names…)  We found rooms at the Amphora hotel—150,000 kip (roughly eighteen bucks) bought a couple beers and cuttlefish snacks, and reflected on the day from our balcony. 

“How’s the neck?”  I didn’t want to bug Cos, but know him well enough to appreciate his stoicism.  Though if it were throbbing, I figured it might be worth looking at options—hopping a bus—hiring a car.  He assured me he was fine, possibly due to the heat and work of riding—one finds oneself regularly turning the head to look for traffic sneaking up behind, which may have served to keep things loose in the land of C6 and C7.  Wisdom also points to the role of the Buddha in keeping things together.  Now far be it from me to go getting all spiritual, but on the way up the Mekong we stopped at a place known as the Buddha Caves, across from the town of Pak Ou.  There’s something like 4000 Buddhas here, and it’s a place of great spiritual reverence.  An old gal was selling little banana leaf and marigold cones with incense attached—or rather giving them away for a donation—and our guide assured us you could light one and make your desires (as in, prayers) known to the Buddha.  Cos was most attentive, and fired one up at the Buddha’s feet before getting down to some serious prayer.  Not sure I’m ready to call this a clear-cut case of cause and effect, life being complicated, but the fact remains Cos’ neck issue seemed to be in abeyance.  

Cos makes peace with the Buddha

The next day dawned rainy.  Somnumbitch.  I had assured Cos this would absolutely not be the case.  Bring a pair of shorts and a t-shirt.  Monsoon’s a long way off…

We poked around a bit before finding a day market with ponchos for sale, then, after the obligatory breakfast of noodles (found a great stall just outside the post office) hunted further for baked goods to fuel our ride.  On the way out of town we passed a Vietnamese stall with banh mi and various baked treats.  Plus, Bonus! A massage parlor next door.  It was kind of rag tag and janky, but we decided on the full body options as a way to ride out the rain.  The girls were rather listless and not so excited about abandoning their smart phones, but turned to their task, including a foot wash, before leading us up to the massage chambers, where we enjoyed a business-like work-over while listening to the rain pelt down on the metal roof outside.  

Probably I could have been more thorough in my research surrounding the next leg—from Oudomxay east to Palming and, finally, Nong Khi along highway 13—a distance of roughly (again) 120 km.  Though the stretch is lovely, there’s some serious up and down. We worked along at a gentle pace, stopping for frequent water breaks, where we also attempted to flag down trucks that might be willing to throw us into their empty payloads for a few thousand kip to shed some serious uphill work, but our efforts proved oddly fruitless, giving way to endless speculation as we sweated our asses uphill.

“Maybe the government—or these boy’s employers— clamp down on  any side action.  Should be clear enough we’d be willing to pay.  Maybe if I held up a 100,000 kip note, in something like a come hither gesture…”  Then—as, it seems, is always the case, an angel descended when least expected, in the unlikely form of a small pickup truck hauling empty blue plastic barrels.  He was parked at the side of the road, a log tucked under his rear wheel to prevent a backward roll down the mountain.  His payload was absolutely full, but desperation being what it is, we figured we’d give it a shot.

“Take us up the road?  Pak Mong?” Followed by a pantomime of hoisting the bikes up top.  The driver rattled off a string of Laos, of which I was able to catch zero.  So I climbed in the cab and opened my Maps.mi app.  I pointed out where we were, where we’d like to get.  He grabbed it from my hands and started working the screen over until he came to a small village.  Then, smiling, he made it clear this was his destination.  I looked it over, and saw it was close to twenty kilometers.  OK!  We settled on a fee of 20,000 kip ($2.50) and Cos and I hoisted the bikes up top, securing them with bungee cords.  Then, just as we were fixing to hop in the cab, a couple of women emerged from the hillside, pulled the log out from under the wheel, and clambered in the small cab, effectively sealing off any chance of a berth.  Hmmm.  Well.  Plan B. We clambered up with the bikes, holding on to the metal rail surrounding the cargo, and commenced a Laos version of Mr. Toad’s Wild Ride on steroids (or crack cocain.)  The two of us alternated between holding the shifting bikes and saving our own bacon as we careened around hairpin turns and hugged the cliff-like tarmac edge.  Then, as we eased into a small village, we slowed and stopped next to three girls (Ten? Twelve years old?) in school skirts and white blouses.  One of the women in the cab yelled something to them, and next thing we knew, they we clambering up with us, holding on and laughing as we lurched down the mountain in our burgeoning madcap adventure. 

What could possibly go wrong?

But all good things must end, and soon we were sweating it out again. Which brings me to another thing about touring in Laos: One needs be thinking about the day’s destination, especially if they’re not toting tents, sleeping bag, etc.  Which we weren’t .  And though we had lights, we felt it best not to be on the road after dark.  While taking a break, I noted the time we had left before dark, and the distance we still faced to a significant habitation, which appeared rather daunting.  Then I saw something on my trusty maps.me, which appeared to be a guesthouse about five kilometers hence.  It was called something like Mountain view, or maybe Hilltop.  (More suitable name would fall along the lines of Place at the top of fucking big climb.)  Whatever it was, we set our sights on it, and before long were bathing in the glow of a couple cold Beer Laos…the unsurpassable taste of which-following a long, hot day in the saddle-can cause one’s very toes to clench in orgasmic bliss.  

As it turns out, we probably could have made the next town, Palming, the day before, as the morning’s ride brought a screaming 20 km stretch of pure downhill bliss through thick mountain mist. We played it safe, as the road was slick with wet and visibility slight, and found when we stopped our clothes soaked from the thick white fog.   Another gentle 30 to 40 km brought us to Nong Khiaw, on the banks of the Ou River, where Cos insisted on springing for a couple of posh bungalows crowding the river. (Not to minimize his generosity, but at forty-some dollars a night, they were a screaming bargain!)

Nong Khiaw

One hates to backtrack, and it turns out our southbound leg back to Luang Prabang required just that.  Then we remembered the advice of a German biker we had met a couple of days before, and consulted a map to reveal a water route from our present location to a village just off highway 13 on the way south, effectively creating a hypotenuse to the base and leg of our route’s triangle (the base of which we had already traversed, and would have needed to re-ride.)  The receptionist at the hotel (really more of a concierge) made a call, and the next morning found a guy with a boat waiting to load our bikes and take us downstream.   

(I’m well aware of the fact we subject ourselves to a certain scorn from the bicycle purist when we boat, jump in trucks, etc., as a means of moving our asses down the road.  To this I say, Are you going to eat that last chocolate croissant?)  Actually, this boat was a tad less posh than the old Shampoo cruise down the Mekong.  Charming in a leaky, rotting kind of way, our little vessel sported the ubiquitous blue paint and tired old car seats of river craft across the land.  It tipped a bit as I stepped aboard, and there remained a lingering doubt, too, as to just how we would be delivered to the stated destination, in that a big old dam has recently been built by our friends in China, but no worries!  Turns out with the dam came a road, and by this means we found our way to highway 13, and commenced some earnest pedaling.  (A four-star boat ride, by the way—fishermen plying the waters with nets, small villages, water buffalo, and towering cliffs. Well worth the price of admission.) 

Bikes on the ride down river from Nong Khiaw

Easy street

And so we found ourselves facing down a sixty or seventy km ride along the very same river to our day’s destination, The Nam Ou Riverside Resort and Hotel, on the banks of the Nam Ou river, some thirty kilometers north of Luang Prabang—a fitting place for our last lesson in real world politics.  The hotel was carved out of a stretch of land along the river, and comprised of a main building with various rooms, and bungalows closer to the river.  Great views, ice cold AC, hot showers that dumped monsoon-like quantities of water over our salty hides.   There was even an infinity pool (which didn’t quite reach infinity, but close!) with the obligatory French and German tourists in tight swimsuits sunning on its decks.  All of this splendor  sort of pushed its ass end up against a small village, which no doubt inhabited the land leading down to the river before this joint was built, and through which we rode on our way to the land of Oz.  

While Cos sorted out paperwork with the desk manager, I rode to the village in search of cold Beer Lao, an admittedly  necessary part of the uncoiling process following a steamy day in the saddle.  Immediately I was surrounded by a group of ten or eleven small children, the youngest of whom couldn’t have been more than two. One of the older boys (six years old?) sported a liter-sized water bottle in which he had drilled some holes in the cap, and through which he proceeded to squirt me on the legs and pants, rendering wet splotchy marks around my private parts.  

“Hey! What are you doing? Shouldn’t you be in school?”  He evidently found my response quite amusing, and proceeded to squirt some more.  I didn’t mind, really, but the adult in me felt a need to better channel their energies—Idle hands and all…

“Where might one find a cold Beer Lao?”  Even as I spoke my jaundiced eye pendulumed up and down the dusty village road—where one typically finds at least one small shack sporting cellophane bags of baked cakes hanging in the entrance, fried bananas, salties and sweets, and a cooler with water, juice, pop, and beer.  Always beer. Not so here, and I briefly considered the possibility our hotel put the screws to the locals, banning sales of beer, forcing us soft westerners to buy essential provisions at the ridiculously marked-up restaurant on site.  (I do shamelessly admit to a tendency toward paranoia when in the grips cocktail hour anticipation.)

But wait!  One of the girls in the group beamed with understanding and indicated I should follow the group.  And so I was led in a rather twisted Pied Piper manner by the children down a small alley into the deepest dusty recesses of our little village—still fending off the pesky lad with his seemingly inexhaustible water bottle as I pushed by bike along!  

There are times when I turn off my capacity for reason; Allow myself to be carried along life’s flows and maddening eddies.  God’s will!  Here it would seem was just such a time.  The children fell into a somewhat embarrassing chant of Beer Lao! Beer Lao!  Onward into the abyss! As we snaked our way into the viscera of woven shacks, laundry,  discarded and broken baskets, I half expected our journey to finally reveal the smiling visage of a large oven door, into which I would be unceremoniously pushed as I leaned obligingly into its warm, gaping belly.   Then, (as must be my fate, in that you are reading this account) there appeared a small opening in a wall and—I shit you not—a blind man (he looked blind, anyway) sitting on a stood just beyond the opening’s edge.  The whole ordeal was taking on Odyssey-like overtones, and I didn’t know whether to ask for beer or guidance as to the will of the Gods.   Slow moving and patient, he smiled as the children chattered bird-like in rapid-fire Lao, the only part of which I understood being the occasional trill of Beer Lao.   Sure enough, a cooler took up the better part of the wall at his back, and through it’s frosty doors I spied the object of my desire.

Beer Lao's ubiquitous presence

Here is the logical end.  But it turns out, there’s one more little thing.  As I was making my purchase, a young, beautiful Lao woman came into the room to see what all the fuss was about. She was wrapped in a long, colorful sheath and seemed to somehow float above the bumpy dirt floor. And, too, she understood me when I gave her a few thousand extra Kip for my purchase, and indicated the change should go to the children, that they might buy themselves a treat.  From a rear counter she filled a woven reed bowl with thousand Kip notes and distributed them one by one into the children’s outstretched hands.  Then, from the cooler she filled a plate with small, pink hot dogs and chicken’s feet-a feast!-which she handed to one of the older children and indicated a table outside the shack. Before they ate, they lined up neatly and each shook my hand while solemnly intoning Kob jai (thank you).  

That night, in the cavernous dining hall, we enjoyed huge amounts of food and even wine. The next day was to be our last, so we unspooled a bit.  Out on the river, we could just hear the slap of a large bamboo pole striking the water—a fisherman corralling small fish into his net. Our own efforts over the last four days involved pedaling nice bikes for the sake of new experience, our dinner bill probably equal to what a family in the village lived on for a month.  

The next day, on our way out of the village, we were run over by a large truck hauling gravel for the dam.  Mostly, we were eaten by pigs, but a couple dogs had their way with our intestines, fighting among themselves for the bigger, juiciest parts.  

R.I.P.

Lao Blah

   In India we call it Delhi Belly in Myanmar- Burma Belly. Not sure what they call it here, so I'll call it Lao Blah. 

   I had every intention of writing a post about the amazing food here and then I ended up with a case of belly upset so I haven't had much appetite or desire to think about food. Thank goodness for the French influence and availability of a good baguette and croissant so I can put mild white bready things in my belly (and the fruit smoothies...)

   Instead I'll just post a few random photos. I work the next couple of days but hope to be well over the weekend so I can catch up on eating and blogging.

Downtown Luang Prabang. We're getting into the hot season so things are quieting down.

Mike getting his meditation on.

Cribbage at our favorite riverside spot

One of many Wats (Buddhist Temples)

Our guesthouse

Mike waiting for his food at the place where I ate the sketchy food that gave me the blahs

Kids playing on the Nam Khan- this makes me really nervous since I work at the Children's Hospital.

A different Wat

Common sight- thousands of monks in this town.

Mike being very un-monkish and enjoying a complimentary cocktail at one of our favorite places.

Lao Friends Hospital For Children

                                    https://fwab.org/laos/

   I’m starting my second week working at the Lao Friends Hospital for Children. Above is a link to their website so you can read more about it but in a nutshell it’s a pediatric hospital that provides Outpatient, Inpatient, NICU, Physical Therapy, Outreach, Pharmacy, Developmental Clinic, Nutrition Clinic, Radiology and Surgical services free of charge to any child that shows up at the doorstep. The hospital opened in 2015 with the goal of becoming self sustaining in 10 years at which time it will be handed over to Provincial Hospital next door.  There is a sister hospital in Siem Reap, Cambodia that opened in 1999 and became an independent self managed hospital in 2013. My job and that of the other volunteer nurses, doctors, pharmacists, lab techs, physical therapists and occupational therapists is to support patient care and train Lao staff in pediatric medicine. 

   Maybe the best way to understand what we do is to take you through a “typical” day although with the warning that anything can throw a wrench into the schedule and usually does.

0630- Get on my bike and ride 4km across town to the hospital.

0700- Handoff with the night volunteer where we do a quick rounds on the patients in the Inpatient Department (IPD) with a little report of what happened in the night. (From my experience the patient population can change very quickly. Patients are discharged at all hours of night and new ones show up. Sometimes a family will make the decision to leave and won’t tell anyone. You’ll just notice that the bed is empty.) Lao nurses pick their assignments. If I’m lucky I have a shift leader who is an experienced Lao nurse who will make sure that the assignments are appropriate and help with checking meds and bed assignments.

0730- I touch base with the Lao nurses. I might make suggestions about what to look for and focus on with their patients. For instance- “please make sure you do very accurate fluid balance  (I&O) records on this patient with renal failure.” We might have a little teaching session about why this is important.  From what I’ve been told and observed, the Lao nurses are very task oriented and they are very good with putting in IVs, mixing meds etc so we are helping them develop critical thinking skills.

0800- I check charts and make note of medication times and look at vital signs, fluid balance, weights. Write down any concerns or questions I might have during ward rounds.

0900- Ward rounds with the volunteer doc and Lao docs. There is always one volunteer nurse and doc on every shift. The Lao nurses attend rounds on their patients. I round on all patients. During rounds the Lao doc presents information about each patient and then we discuss pathophysiology, medications, labs, diagnostics. There is a lot of teaching done by the volunteer doc. As a team we’ll come up with a plan for treatment for that day. The plan can change every day, mostly due to the fact that we are very limited in our resources. 

     For instance- a kid might come in with what we think is some bacterial illness but we can’t test for it so we treat as if it is Typhoid but if they don’t respond we might switch gears and question if it’s something different- maybe Rickettsia- which (guess what?) we also can’t test. It just is what it is. We do the best we can with what we have. We had one patient that we thought was bleeding somewhere and I asked if we could do a stool guaiac  (looks for blood in the stool) and a medical student I work with said “if you can see or smell it we pretty much don’t test  for it.” It really makes you change your way of thinking. We can’t just do a bunch of tests because either it’s not available or it’s a waste of limited resources. We do have x-ray and ultrasound but to get a CT scan we have to take the patient to Provincial Hospital next door—where we have to pay for it—so its carefully considered by the medical director as to whether its warranted. Any money we give to Provincial for services takes away from what we can provide free to our Lao patients.

    Back to rounds. It goes on for hours depending on how many patients we have. The longest I’ve attended was 4 hours. It’s very comprehensive and educational and has been a great refresher course in pathophysiology and pharmacology. After the inpatient department rounds we head to the NICU to do rounds.  On day shift there is a volunteer nurse working with a Lao nurse (thank goodness!! I’m terrified of those tiny babies!) On night shift there is no volunteer but always two experienced Lao nurses. So far it’s been fine but there is a panic button that the NICU nurses can hit if they need help that sounds an alarm. I live in fear of that alarm.

    During rounds or really at any time during the shift I get pulled away to double check med doses, open the narc box, assign a bed for a patient that has come through emergency or the operating theatre (OT) or oversee any type of emergency that is happening. I also need to touch base with NICU now and then to make sure they’re doing OK.

1400-1700-ish- Make sure everyone gets their breaks, meds are given, help with treatments, admit and discharge many patients, teach about disease processes and medication. Also the Lao nurses are scheduled for English classes and might take off for special training. They also attend classes on body systems, pathophysiology etc. This last month they were learning about the renal system which was good since we had our first dialysis patient in the last couple of weeks (sent to Provincial Hospital for treatment.) While this is all happening in the IPD there is an outpatient clinic that sees dozens and dozens of patients a day plus an emergency department that sees many patients too. The other day I checked the patient tally on the board at the Outpatient Department and they had seen 78 patients thus far- all by 2:00 or 3:00pm. Also a developmental clinic and PT and OT upstairs. When I show up to work in the morning there will be dozens of families camped out everywhere waiting to be seen.

1700-1900- touch base with the Lao nurses about charting, make sure meds are caught up and they understand the plan so they can report off to the next nurse. Basically try to straighten everything up for the next shift. After about 6pm we don’t have access to lab, pharmacy  or x-ray until the next morning so we try to make sure any lab tests, diagnostics or meds we might need are taken care of. Sometimes if it’s been particularly chaotic we’ll do a mini rounds on everyone to make sure we haven’t missed anything.

1900- Handoff to the night nurse.

1930- Ride home. Eat. Sleep. Repeat.

I am on the night shift at least once or twice a week. It’s pretty much the same routine except we have no lab, pharmacy, x-ray etc. That really can change how we treat an emergency. We have to do the best we can and guess what is happening instead of being able to rely on labs or x-rays. Also the Lao nurses and docs take sleep breaks. I suppose I could put the volunteer doc in charge and sneak off for a short nap but I don’t. I like to be around to keep an eye on things and I think I would wake up sleepier than before. So I just tough it out.

Right now we’re short on volunteer nurses so I worked four shifts last week and I work four this week. After this week it’s back to the regular schedule of 3 shifts/week. They always bundle your days so you have at least 3 or 4 days off in a row and in the middle of March I have almost a week off.

We do have some typical patients. 

-Gastroenteritis, dehydration and lots of malnutrition and worms. Every kid (inpatient or outpatient) gets a dose of vitamins and albenzadole for worms. 

-Beriberi- thiamine deficiency in babies because mom is following the taboo diet during the postpartum period, meaning she has food restrictions because of cultural beliefs. The rice in her diet is polished and washed over and over and the B vitamin is stripped away so baby doesn’t get it in the breast milk. It can be very debilitating but baby makes great progress with a dose of thiamine and mom is given some too and sent home with it. Outreach is working on education in the villages. 

-Preventable diseases due to lack of vaccination. Outreach is also working on this. 

-Thalassemia, an inherited anemia requiring frequent blood transfusions. We have a thalassemia clinic every Thursday with kids coming in for transfusions. There is a huge need for blood here. They run frequent blood drives. I haven’t been able to donate in the US for years because of our exotic travels but they don’t care here. Plus I’m O neg so very much in demand. I’ll donate on my next day off. Mike’s already done his duty. 

-Traumas, any and every thing you can think of. It’s very common to see whole families on a scooter with only dad wearing a helmet. I’m especially sensitive to this now. On my day off as I ride around town I find myself cringing at potential accidents. Lots of orthopedic surgeries. There is a huge problem in this country with UXO (unexploded ordinance- land mines and unexploded shells from the Vietnam War.) I know it’s a bigger problem southeast of here so I haven’t seen any patients who have injuries from that- yet.

As a rule we follow guidelines from the World Health Organization for treating these conditions. I just found out that our Medical Director is considered the leading expert on severe malnutrition in resource limited areas. His research has changed the way malnutrition is treated in the world.

Families are very loving, attentive and sweet with their children. There’s always one family member with every kid and the rest of the family is usually camped out in the family area outside. They take turns coming in and providing care- bathing, helping with toileting, feeding. There is no food provided by the hospital so they either cook in the communal kitchen or buy food from the canteen during the day. Besides the cooking area, we provide bathrooms, showers and mats for sleeping. During the night there are patients and their families sprawled all over the ward or outside. As a rule these people are very poor and come from villages far away from here. They might travel up to 8 hours for care. Often  parents use the local shaman for medical treatment before they come to us so sometimes a kid comes in and we’re not sure what they’ve taken as far as medication/toxins/treatments. But they really do mean the best for their kids- they are in no way negligent, just don’t know any better. They’re receptive to our care and seem very appreciative. The people are really shy, stoic and somewhat reserved but quick to smile.

Any child can come for treatment and many times a western kid will come through with some illness. We don’t require any payment but ask for a donation for services (for instance a CT scan is 800,00Kip (about $100) a unit of blood is 80,000Kip ($10.)  They are always grateful and happy to pay.

We have 22 beds in the IPD and 10 beds in NICU but we won’t turn anyone away so sometimes the halls, ED and treatment rooms are filled with patients too. Thursday I had a bed with two patients in it- sisters both getting transfusions for Thalassemia. A couple of days ago we had 24 In the IPD, 12 in the NICU and 2 in the ED. We always find room for more. The Lao nurses and doctors stay very calm and cool during emergencies and through all the chaos. They understand we can only do what we can do. I try to take a breath and stay calm because it's true.  Acuity is very high. We’ve had a couple of kids die just in the last week. It’s been a very intense, emotional and rewarding experience.