It’s funny how after a week of being down here in Ko Pangan, arguably the most fun island in Thailand, therefore the world, the only thing that really made me happy was booking my bus ticket back to Bangkok. I’ve never wanted to be in Bangkok before, but now I can’t wait to get there.

The past week here has been relaxing at best, lonesome at worst. In other words, it’s been exactly what I’ve wanted it to be. I needed a place I can sit and be bored to pieces at, somewhere I can spend a full day stoned out of my mind, staring at the waves and doing absolutely nothing. I needed to have that just for the purpose of snapping out of it later and wondering what a waste I’ve been. I needed that so that I can look back a few weeks from now and be glad to be back in med school. I needed it and I got it.

I found this bungalow on a deserted corner of the island, where I’m the only guest I’ve seen who stays more than the day it takes to come here and get the hell out. I stayed because I found my own personal, private beach where I can, as I said before, sit and watch the water come and go for hours and hours until I snap out of it and think of something more productive. Unfortunately, in those circumstances “more productive” thoughts tend to be thoughts of loneliness, boredom, and even depression about why the hell I’ve exiled myself from humanity.

The nights haven’t been much better. It’s about a 30 minute drive to the “happening” side of the island, where I’ve spent almost every night since I’ve been here. Unfortunately, I’ve never seen more “hard to meet” people anywhere else in Thailand that at that beach. It doesn’t help that this time I’m here, it’s summer break so all the beaches are flooded with everyone’s favorite stereotypical douchebags. The bright side of this is that I’ve seen some of the most beautiful women I’ve ever encountered. The dark side is that I’ve only met a few of them. Also, it’s a lot harder to distance yourself from every other stereotypical drunken douchebag when there are just SO MANY of them everywhere you go. I’ve never, ever thought traveling in a group would be more fun than traveling alone. At Had Rin beach in Ko Pangan, I finally see the appeal.
The nice thing about my trip to this island is the massive amount of work I’ve been doing, which considering that was my primary purpose, makes the rest of my worries inconsequential. I’ve written a complete report about the survey, which will be used to help write a paper for eventual publication. I’ve also written a pioneer draft of this Ayurveda paper that might seed another paper later down the road. Oh, and I managed to study half a week’s worth of Cardiology (the week I’ll be missing for Burning Man). Not bad for a week’s work.

I made it successfully out of Mae Sot and into Chiang Mai, still my favorite city in Southeast Asia. I made it four days, met a few good people, and started my 2-day trip down to the islands. I was on a bus for 12 hours last night, and here I am in Bangkok waiting between 6AM until 6PM for my night bus that'll take me 12 more hours before I get to the port where I take another boat 3 hours out to Ko Panghan. It better be worth it...

But the plan is to find a cozy little bungalow somewhere on the beach and lie in a hammock for a week while I write this research paper on what I did in Mae Sot. If all goes well, I might write two. Either way, I'll have a good enough chance that I'll get at least one paper out this summer.

I wish there was more to say, but I've been basically drinking and sleeping since I left Mae Sot, so there's nothing aside from party stories worth posting. Sorry.

I've spent all my time so far posting ramblings about my situation, so I guess I should probably back up and state what it is actually that I'm here to be doing.

I somehow managed to convince my University that it would be an "investment towards my medical education," as well as maybe even for the world as a whole, to fund a summer trip to Thailand on the Burmese/Thai border to study traditional medicine use among the recently (illegal) immigrants who've been raped, pillaged, and chased out of their homes through minefields to come seek refuge in a country that so adamantly doesn't want them that they forbid them to be anywhere outside of home, with the lights off, and not even use cellphones, after 9PM.  So there's a public health clinic here that was setup by a Burmese doctor 20 years ago (who has since been named the "Mother Teresa of Burma"), that treats people for a dollar.  About half of the patients are immigrants or displaced people, and the rest are simply migrants who cross the border daily for work (or sometimes just for treatment at the clinic).  Come to think of it, it'd be kind of like a public health clinic in San Diego.  Except with more malaria and amputees.  And (I think) more fouled up penis oil injections that end up in thigh skin grafts (see that post).

So there's a war going on that nobody I know has ever heard about, that's been going for over 40 years.  The Karen (car-REN), an ethnic "minority" group that was considered by the British to encompass several sub-groups to categorize about 50% of the Burmese population, has been fighting one of the most brutal military totalitarian regimes since the end of the second world war.  Burma, with it's 500,000 troops and endless workforce of villagers forced at gunpoint to be their workhorses, have almost completely routed the Karen insurgency and terrorized millions of villagers out of their homes.  The Karen still have a complete government, that exists in exile in Thailand, and they control everything from their army to their healthcare system. 

Of the whole team of Westerners who've come from far and away to help the exiled government re-organize their infrastructure, teach their medics, build schools for refugees, and buy drugs to put on the backs of medics who make 3-6 month treks into Burma to provide medical care to the remote villages, my job has very little to do with any of that.  Instead, I'm focusing on making the helping the displaced people and not-yet-emmigrated people more self sufficient in a way that doesn't involve a constant stream of international goodwill and aid money. What we're about is bringing back self-sustainable healthcare to these villages who've had it for thousands of years in the form of herbal medicine. Until the Burmese military government cuts down all their trees, the Karen people have one of the largest pharmacies in the world growing right out their front door. Unfortunately, with a 40 year conflict such as this one, the teacher-pupil relationship that carried this information through the ages has become severely endangered. Now there's a push by the exiled Karen government to centralize all this information, re-test it, and distribute it among the villagers through a program of herbalist training centers and spreading handbooks of traditional medicine to the villages directly.

I'm here to conduct a survey at the local "almost-free" clinic to see what kind of information I can extract from the patients about what should be done to the healtcare system once they get here. In the meantime, I found out about an herb that cures Hepatitis B, and another herb that apparently treats HIV. These are all stories that I'll cover later. For now, I'll say that the Hepatitis B herb is currently being studied, and that the HIV treatment has been somewhat lost because the member of the clinic who was able to find the herbalist who administered the treatment was shipped off to another country for resettlement (another victim of the brain drain), and so the herbalists that were able to treat this woman (who did gain weight and apperaed significanty healthier in the same way HAART therapy would appear) cannot be found. India's been launching an investigation about herbs that could potentially treat HIV as well, but we'll see either how much it works or how much the profiteers don't want us to know about it in the coming years...

I know that didn't answer much about what I'm doing here but it gives you a tip. For now, I'm drunk and I'm tired and I can't be bothered to write anymore and there are two people who want to use my computer. I'll do my best to finish this idea later.

I forgot I never really explained myself when I said that the refugee camp was one of the most beautiful places I've ever been. In lieu of that, I'm sure I sounded like a psychopath again. At least a sociopath. Nevermind, this is why:
It's that the people there were some of the worst off people in the entire world, and here they were building a community out of nothing. More than that, it's as though entire communities had retransplanted themselves onto this beautiful landscape, renamed itself after names of the old villages, and went back to daily living. From what I understand, a new family arrives from their most recent massively traumatic experience, after hiking for a week in the jungle to get to safety, and they're helped in all ways by the experienced folk who'd been there for a few years now. Suddenly, they go from running in the jungle with a baby on their backs, dodging landmines to avoid the Burmese military who's chasing after them, to having a little shack with some fellow villagers they may have known in the past. They get food, water and shelter. Now all they do is wait.
In the meantime, the place has become infested with children under 10 years old. The camp's been there for almost 20 years, and waiting has turned into a way of life. But the kids don't know any better. They love it. There are giant soccer games, and children laughing and playing up and down the muddy banks of the hill.
I heard that yesterday the Americans came with 8 large trucks and took 320 people out of the camp for resettlement in the US. Now THAT's impressive, something I'd assumed was acompletely given up in the midst of all this recent anti-immigration furor. They promise to take 10,000 refugees per year, and other countries like Canada, England, and i think Australia are taking smaller amounts. On one hand, this is great considering there are only 150,000 refugees sitting in camps along the border. On the other hand, the Burmese are taking this as a "go ahead" to kick more natives down the mountain to the refugee camps on the Thai side. For every refugee that gets resettled, they say, two more come in.
Another side of the story is that we, as Americans, tend to take the best and the brightest from the world. Of course, it only makes sense for us to do, but this means that the medical clinics in these camps are consistently drained of their staff. The clinic in the camp I went to said they had 33 medics at the end of May. Now they have 28. By the end of the month, they'll have 23, and they'll be down to a dozen by the end of the rainy season. That's a dozen under-trained staff to handle about 60 beds (I wasn't counting very carefully), a pharmacy, and a complete outpatient department during the height of the rainy (disease) season in a refugee camp of 50,000! Understandably, they're rapidly training more staff with intensive, incomplete courses of 7 months instead of 18. The US has a policy of resettling refugees based on their relative "risk." Whatever that means officially, educated refugees are much more valued.
It turns out there's also a population of Indians and Bangladeshis who come to the camps in hopes of getting resettled as Burmese. Now there are members of the American resettling staff whose job it is to try to determine who's really Burmese and who's not.
There are also Muslims in the camps. As our guide told us, even though they make up only a few percent of the total population, when resources get scarce they're the ones who cross neighborhood boundaries to steal from the other side of town. This is the local opinion of Muslims who have absolutely nothing to do with the Muslims that make the headlines anywhere else in the world. I should probably also say that 60% of the camp is Christian.
That's enough for now.

The third full day of the survey, I get led into the "trauma surgery" room to interview one of the staff right next to a "sterile" bed with a man lying on it who was getting his penis re-wrapped. It was open when I first got there, a bright red bloody mess of what was supposed to be the shaft, between a normal head and scrotum. It was kind of a leap of professionalism for me to have been able to sit through an entire interview, and even pay attention, while a 30 year old man was lying in excruciating agony (without uttering a peep) as a pretty 25 year old girl medic wrapped his massively enflamed manhood in a new set of gauze. He left about 5 minutes later, and I had a brief pause of full interest into what I was hearing through my translator, and then ANOTHER man waddles through the curtains and lies down on the bed, exposes his Johnson, and gets the re-wrap. Throughout the course of my 30 minute interview, three people in total had to have their penises rewrapped.
Fortunately, I'd heard about this before as an epidemic phenomenon that nobody's really talked about. Ethnic minority villagers would go get subdermal oil injections into their dicks, so that the oil would spread along the entire shaft to increase girth. Nobody has any idea how many people actually get them, but the hospitals see a new case of a very sloppy (and infected) job every two or three days. The best case scenario is a complete skinning of the shaft, replacing it with a graft from the thigh. There have been several cases of amputation.
They only really see it in the camps, which means that either it's something that has been brought down from the hilltribes that has never been seen in the cities (along with a lot of other strange rituals and habits), or it's an entirely new phenomenon. The latter option suggests a great opportunity for sociological research, as it's very likely that this is the natural response to the demasculization that's occurring in these refugee camps. When it's the man's role to supply and provide structure and stability to his family, he's so utterly demasculinated when his family is forced out of his house at gunpoint and flees to a refugee camp where work is scarce and food is provided free of charge. He should at least be able to please his wife...
Who knows? It's not my work, in any case. There's a long term survey that's being conducted at the clinic to find these things out, so the exiled Karen government could impliment some sort of education about it at least.

Refugee Camp

I finally made my way into visiting my first refugee camp. It’s closed to tourists, and so I halfway figured I’d never even get to see it. But one of our contacts here happened to be going there to speak at the opening ceremony for a new “college,” and we were able to come along.
This might have been the most beautiful place I’ve ever been. Having said that, I should then mention that it’s home to some of the most brutally destroyed human beings that currently exist in the world, in that just about every member of the camp has had just about the worst thing imaginable happen to them. I didn’t get a chance to meet anybody personally, but I’m staying at this guesthouse with a couple who’s filming a documentary about the situation. They went to the same camp a few weeks ago on the specific mission to interview the new comers. The people they met were still shell-shocked, telling stories of their closest family members being raped and/or murdered while they were forced to watch, and then being forced to walk minefields by the Burmese military in order to clear them. It wasn’t that each person had their own story, it’s that each person had 10.
So I went expecting something out of a Save the Children ad about African refugee camps, or something I’ve seen on TV about the camps in Gaza. Instead, we drove into a mountain region with a gigantic sheer rock face on once side that rivals Yosemite in majesty, and the driver told us we were here. I didn’t see any buildings at first, and then as we drove further we saw little shacks that looked like Tiki huts nestled between the massive trees of the deep forest. As we drove further, more and more huts appeared, and closer together, and it became apparent that each hut was almost identical. A wooden platform, on stilts, with a floor, and an angled roof made from thatched leaves off some of the local trees. We drove on, and the huts got closer and closer together until we could see nothing but thatch leaf roofs, mud, bamboo struts, and kids behind a wire fence.
The driver took us in. It had been raining all week, so the packed dirt road had turned into the kind of terrain that I’d have thought only a 4wd would dare enter (I brought this point up later with our guide and he said they can drive any crappy car through it if you’re good, which realize how wimpy us Americans tend to be about these things). It was muddy, it was dirty, and the bamboo floors of the huts were wide open for us to see how they served as living room and bedroom for the whole family. But we got down to the basin to find a giant soccer field with a thousand people sitting around watching a match.
Just next to the soccer field was the local health clinic, which I got to tour and I’ll discuss in a later post.
But you could already tell the attitude was so much more complex than I’d ever imagined. As we walked up the hill to this school, people stared at us while children laughed at us and followed us around, while babies were screaming behind closed curtains of other huts. Meanwhile, we were slipping and sliding to try our best to get up this mountain, as the dirt road had turned completely into a mud road. I’d worn my more respectable clothes, it and it was a bit embarrassing to have to grab hold of huts to keep from falling over into the god-knows-what-its-made-of mud.
Then the weirdest thing happened. We got higher up and I swear I could hear the sound of a marching band. Then I climbed even higher and it got louder. Eventually, the mud cleared and I had a chance to wash my shoes, after which I climbed a bit higher and was greeted by a girl wearing a white schoolgirl outfit. She shook my hand and said “Welcome.” Marching band music was playing louder behind her. My guides have gone ahead, and I was completely baffled. The mud path became a dirt path and eventually became a paved walkway that led to more concrete and eventually real buildings. Then another school girl shook my hand. Then a very important looking person in a suit shook my hand and pointed me upwards towards a bigger building. By then I was very sure there was a marching band in this building. I got to the entrance and started taking off my shoes by the large pile of shoes outside the doorway. I took one shoe off, and then was stopped by a very embarrassed, polite, super smiley person who also looked important, who told me it was not necessary for me to take off my shoes. So I put them back on, even more confused, and walked into a room of barefoot people with muddy disgusting shoes on (were they being THAT polite to a foreigner?). The noise of the awful marching band was deafening. They were also sitting down, not marching, in a closed room. The tuba missed every third note. Then I was approached to sit in one of the chairs on stage, where I’d noticed my host was sitting next to some important looking Karen people and a white guy. The white guy organized the funding for this school. We sat next to him because I think they thought we were other funders. Whoops.
Anyway, I had to sit through a very long and tedious opening ceremony in the front row on stage, which meant I wasn’t even allowed to close my eyes to rest them. However, it gave me a great vantage point to take several videos of some of the musical performances the students had put together, and some of them were awesome. I’m going to compress them and put them with a pack of photos to send out, but I don’t feel comfortable putting them up on a public space like a this. Anybody who wants them, please email me so I can send them out to you.
I gotta go get some dinner, but there should be a lot more to say tomorrow after this meeting. We’re also training our translators for this survey in the afternoon. If I have any energy left, I’ll write it all up.