28.8.05

Elcho 4 - Goodbye

I flew back into Melbourne last Saturday – immediately assaulted by a 6 degree morning. Basking in the 30+ degree days on Elcho Island I had forgotten what it was to feel cold. My memory has now been rather violently refreshed! I have now started a 6-week Psychiatry rotation in Frankston, and look forward to catching up with you guys again.

Family
My sweetest memories of the last week on Elcho Island come from time spent with my Yolnu family. This included more trips out bush, fishing, playing music and listening to stories of the ‘old days’ from my Ngandi (mother). Now an energetic 65yo, she was 3yo and living on a remote Homeland when the first white men (missionaries) came to Elcho Island. Along with most other families, she moved into the Mission – established at what is now the town of Galiwin’ku. Her memories of the ‘mission days’ are very positive, with good schooling and everyone engaged in productive employment. Since the missionaries left (in the 1970s), things have gone downhill dramatically – with loss of Yolnu leaders, no respect for traditional law, and laziness.

As one of the older Yolnu on Elcho Island, she has a unique insight into traditional law and possibilities for Yolnu to truly achieve self-determination. The majority of young Yolnu have little interest or respect for traditional law – but an equally poor understanding of “Balanda” (Western) law and culture. The latter is unfortunately largely based on American rap culture, one of the few models of successful black people available to them.

Interestingly, music and art have been some of the few avenues Yolnu have been able to consistently find expression. My last evening was spent with my brother (Marcus) and cousin (Manuel) – who are musicians blending Yolnu and Balanda sounds and values. Formally a member of Yothu Yindi, my Manuel now fronts a band called “Saltwater” which has broken into the mainstream music scene and will play at the Commonwealth Games next year. I had a great time learning songs, language and traditional dances from them.

Death et cetera
During orientation, my cultural educator spent an inordinate amount of time discussing death and all the cultural intricacies associated with it. While I thought it was overkill at the time, I now realise why it was so important – as there was a funeral on Elcho every week, contributing to an uncomfortable atmosphere of grief and tension and much social disruption. I was able to attend a number of ceremonies, and will recount my very limited experience and understanding of this.

Following the ‘passing on’ of an Aboriginal person, dominant culture rituals take precident initially (certification, autopsy, coronial input etc.) – which invariably means removing the body from the community to Darwin. Grieving is put on hold until the body returns, which means the return is even more saturated with emotion.

A ‘hearing ceremony’ takes place upon reception of the body, which begins with various traditional rituals to welcome the soul back home. With all relatives present (up to 100 people), a heated discussion then follows as logistics of the funeral are worked out.

Returning the body to its Homeland takes place up to a week after its return, with many smaller ceremonies in between. This holds most comparison to a Western funeral or memorial service, with all relatives and much of the extended community attending. Traditional dance and song take place, which are specific to the family, clan and Homeland. Family and community Elders then have their say – which may cover many topics, but never directly relating to the deceased person. Secret women’s and men’s business then occurs, with the physical burial being a more private affair.

As you can now appreciate, funerals mean total shutdown of everyday activities for many Yolnu – even if they are only more distantly related. On a practical note, this means that the Health Centre closes (except for emergencies) at every major ceremony.

Traditional Law
You may have heard recently the results of a Coronial inquiry following a spate of petrol-sniffing related deaths around Alice Springs. Aside from the many issues of substance abuse, this raised issues of the position of Traditional Aboriginal law in Australia. A few weeks earlier, an Elcho Island offender was handed over to Yolnu Elders for traditional punishment - a landmark Supreme Court decision. Currently, Aboriginal people are the most incarcerated ethnic group in developed countries – subject to an irrelevant, ineffective and often downright cruel and unfair justice system. This has been seen as a very positive step forward, both recognising traditional law as legitimate and returning some authority to traditional Elders to implement change in a meaningful way.

Conclusions
Saying goodbye to Elcho Island, and the many friends I made in my short 6 weeks, was difficult. I have learnt so much about Aboriginality and what it means to be Australian. I have few answers, hundreds more questions, and a much better appreciation of the issues facing Aboriginal Australians. I would love to come back up to the Northern Territory as a doctor, perhaps a few years down the track …

Until next time, Djut djut (goodbye)!

10.8.05

Elcho 3 - Flying to the Homelands

Looking out my window, I see the sun sinking below the horizon, splurging a red glow across the sky. The moon and evening star already hang in the clear sky, as a rare cool breeze washes the remaining heat from the air. The last week has flown by, and it is with some sadness I realise that I have only a little over a week left here on Elcho Island.

Thanks to all of you, who have written to me during my placement, much appreciated. Until next time, Enjoy!

Flying out to the Homelands
Last week I had the opportunity to join a community nurse on a trip out to Mapuru, a remote Homeland across on the mainland. Sitting shotgun with the pilot in the 5-seater plane, the views were simply breathtaking. As far as the eye could see stretched red plains, covered sparsely with tall Eucalyptus trees. Occasionally, the black streak of a river, or the treeless streak of a road, would break the monotony. Disembarking the plane into a cloud of red dirt, I stepped into the welcome of one of Arnhem Land’s many beautiful Homeland communities.

Mapuru is home to around 60 permanent residents. However, hundreds more drift in from surrounding camps for community occasions such as funerals (which are unfortunately all too frequent). The dozen tin-sheet buildings provide residences, school and store for the Mapuru community. A recent addition has been a small 2-room building for clinic visits (which occur every fortnight or so).

The local guys jumped at the chance to see a male health worker, and my morning was spent seeing a steady stream of patients. The health of the Mapuru community was very encouraging – alcohol was absent, kava and cigarette use minimal, hygiene relatively good, and health skin highly prized. The latter gave me much amusement as guy after guy requested moisturising cream to keep their skin positively glowing.

With us on our flight back to Galiwin'ku was a young boy with a tender, inflamed knee. Possibility of infection or rheumatic fever meant he would need observation and, if necessary, evacuation to Nhulubuy or Darwin. Fortunately this did not eventuate, but it once again highlighted the challenges of living in a remote community.

Real-life Cowboy
Among the array of characters I met at Mapuru, was Alfred – an original Aboriginal cowboy. His lanky frame decked out in tight jeans, flannelette shirt, cowboy boots, big buckled belt and broad-brimmed hat perched on his bushy white hair, he certainly still looks the part. As he talked of breaking in wild broncos and hustling cattle overland, the loss of horse and saddle was obvious.

Alfred epitomises the many “warriors” who have lost their role and value to society. The host of traditional knowledge he and the Elders hold, its value unrecognised, is sadly being lost forever. The welfare mentality is now an entrenched part of the worldview of almost all my generation and beyond. As Aboriginal leader Djiniyini Gondarra said, “dependency is the biggest disease that is killing Yolnu today”. The reward of hard work, so valued by their Grandparents, makes little sense in the current welfare state.

As I watched Alfred sitting cross-legged in the sandy shade of a tree, I realised that he was one of the lucky ones. For so many others, this loss of roles and self-value have led to the destructive clutches of alcohol and other drugs, gambling, and violence towards themselves and others. And sadly, those who opt for suicide are not the “no-hopers”, but people who could make a difference, but have seen all hope disappear before their eyes.

Yolnu Heart
Children have a way of revealing reality in such a naked, honest way. One afternoon I walked down to the beach, my mind a jumble of thoughts, as I tried to clear my head of the heavy feeling of loss that seems to blanket Galiwin’ku. Settling on the hot sand, I watched a group of a dozen young boys splash about in a large rock-pool. Noticing me, one of the older boys trotted over and struck up conversation.

I spent the next hour swimming, being half-drowned, rolling in the sand and reclaiming the innocence of childhood with these 12 Yolnu boys. Hearing me struggle with Yolnu Matha, they eagerly taught me all the important words – water, boat, shark, crocodile... They left the beach with me, accompanying me back home, where they quickly set to work raiding raiding my fridge, before becoming engrossed in some ABC Kids TV program. As their visit came to an end, and I settled down to clean the fresh layer of red dirt through my entire house, I felt a sweet reinvigoration. And as I remember their sea-swept hair, big brown eyes and gleaming smiles, I am convinced that the Yolnu heart is still beating as strongly as ever.

Plans
Plans are all progressing well.
  • More Homeland visits next week.
  • Going bush again this weekend.
  • Footy and basketball are on hold – my ankle is giving me grief again.
  • Still not sick of the beach and, croc-willing, plenty more to come.
  • Men’s cultural centre is still on the cards.
  • No time to go to school, but plenty more community contact to come
  • Hep B management and screening protocol in action

1.8.05

Elcho 2 - Yolnu Family

It’s another beautiful sunny day on Elcho Island – the jewel of Arnhem Land. In the last week I’ve played footy, gone bush, swum with a croc, been adopted, made some fantastic friends and done some great medicine.

Thanks to those of you who have emailed or written, much appreciated!

Adopted Yolnu Family
Hi, my name is Wangirri (meaning grey heron bird). I am from the Dhurrkay family, part of the Wangurri tribe, and my skin name is Bangadee. Last week I had the privilege of being adopted into a Yolnu family by one of the “Strong Women” workers at the Health Centre. I’m still learning what it all means, and who all my relatives are, but it has opened up a lot of doors into the community. One of the first questions people ask is have you been adopted; then proceeds a lively discussion of how you are related to them, who you know, and where you live.

Going Bush
On the weekend, my ‘ngandi’ (mother) took me out bush to her Homeland. With 10 of us piled in (and on) a ute and we bumped over the sandy track up to the north end of Elcho Island. The scenery on the way was amazing – lots of wildlife, beautiful flora, and many little bushfires cleaning up after the cyclone (last wet season). The day was spent at a beautiful beach: fishing; netting; catching crabs; cooking damper; lots of eating; swimming; and snoozing under trees. I came home hot, exhausted and somewhat red – and looking forward to next weekend!

Crocs, crabs, cockatoos and other cool creatures
My curiosity has been having a field day out here with so much to explore. Wildlife is such an example. The other day I spotted a frill-neck lizard, who liked me so much he opened his frills and blew me a kiss (or was it a hiss, hmmm). Black cockatoos, hawks and sea eagles are regularly spotted gliding overhead. Dozens of crazy little hermit crabs scurry over the wet beach sand. Fish fill the waters, and I’ve even spotted dolphins leaping out in the sea.

But most exciting was my discovery down at the beach the other morning. It was the first time I’d visited this particular beach, and as I scrabbled down the rocky cliff overhanging the beach, I spotted a black rock-like object just offshore. When it fully surfaced and began gliding towards deeper water I realized it wasn’t a rock, but a crocodile – and a big one too. Being familiar with Steve Erwin’s efforts as the Crocodile Hunter, and with “see one, do one, teach one” running through my head from medical school, I hurried down to get a closer look. [This is the part where I’m meant to bring the story to climax with a dramatic escape from the jaws of death. However, that may be pushing creative license a little too far. So I’ll leave it at that, and allow you to form your own satisfactory conclusion.]

Health
Work at the clinic has got rather busy lately – as I’ve taken on a few little pet ‘projects’. These involve: Men’s Health; Rheumatic Heart Disease; and Hepatitis B infection. You heard about my role as the “Men’s Health Sexpert” last letter, and the jobs just grown since then.

Rheumatic Heart Disease (RHD) is a serious condition involving heart valve damage following a simple throat or skin infection. The highest rates in the entire world are recorded among TopEnd Aborigines (for reasons unknown). A number of kids got picked up with heart murmurs (possible RHD) at a recent school screening, so my job is to follow them up and make sure they get seen by a Cardiologist. This is proving more difficult than it sounded – when I visited the school last week not a single one was in attendance. I was told that they “could be anywhere in Arnhem Land” (such is the mobility of the population here).

Hepatitis B infection is also very common up here in the TopEnd (estimates as high as 10%). While acute problems are not too bad, Hep B can lead to liver cirrhosis, failure and cancer later in life. Until now, chronic Hep B carriers on Elcho have not been followed up adequately and no testing has been done on their household contacts. [The mistaken logic has been that Yolnu here don't live long enough to get the complications] So over the next 3 weeks I’ll be attempting to follow up all the Hep B carriers and their families as I can find. If all goes well, I’ll have a workable protocol to leave behind. The Darwin CDC (Centre for Disease Control) are the authority on this sort of thing up here, so I’ve had lots of guidance from them thankfully.

Newsbites
There’s been a few significant happenings outside of my TopEnd experience recently:
  • My sister, Serena, has just got engaged to Matty King (a top bloke and close family friend in Tassie). So huge congratulations to them! And best wishes for planning next year’s wedding and move to China!
  • Job offers for Internships next year have just been released. After a difficult choice between two very different jobs (Alice Springs District Hospital, Monash Medical Centre in Melbourne), I’ve accepted a job at Monash Medical Centre. So I’ll be based in Melbourne for another year, hopefully with a couple of terms at rural Victorian hospitals.

Plans
Last email I listed some plans for my stay here – here’s how I’m going:

  • Visiting communities out in the Homelands – fly out with Homelands Health on Tuesday
  • Meeting the Traditional Land Owners – yep
  • Going bush, maybe even some hunting and fishing – yep and will do more
  • Playing basketball and footy – footy yes, b’ball not yet [Footy was a real experience. Picture 50 guys on a dirt/gravel oval, shirts vs skins, all in tussle. It was the first time in footy I’ve been outrun by so many other guys. Had an awesome time – returning with cuts, grazes, bruises and a layer of red dust covering me. Loving it!]
  • Lots of beach and swimming – yep, and more planned

And here are some for the coming weeks:

  • More of the above…
  • Visit the Men’s cultural centre
  • Spend time at the school
  • Establish the Hep B management and screening protocol

21.7.05

Elcho 1 - Welcome to the Island

It’s been an exciting first week up here in the TopEnd of the Northern Territory. After a few relaxing days in Darwin I flew out to Elcho Island, where I’ve begun work at the local Health Centre. The weather is a gorgeous 30 degrees, with clear blue skies, long sandy beaches, and a crystal sea. Not bad for a university placement!

I’ll email out a few letters to you during my 6 weeks here. Enjoy reading! If you’d like, you can drop me a line. My contact details are included below.

Address: c/o Ngalkanbuy Health Service, Galiwin’ku, Elcho Island, NT 0822
Ph: (08) 8970 5105 [home] or (08) 8987 9031 [work]
NB: no mobile coverage

Elcho Island
Elcho Island lies off the coast of NE Arnhem Land – a couple of hours by plane from Darwin. It is home to around 2000 local Yolnu (Aboriginal) people, most of whom are scattered throughout the “Homelands” in small groups. I’m located at Galiwin’ku, the main town at the southern tip of the island and home to the island’s limited services: Health Centre, general store, 3 takeaway shops, Council office, church, child-care and airport. I live in a little blue house only 100m from the Health Centre, 5 minutes walk to the shops and less than 10 minutes walk to the closest beach.

Ngalkanbuy Health Service
Ngalkanbuy Health Service is based out of the small but well-run clinic here in Galiwin’ku. I work alongside 1 doctor, 3 nurses and 5 (Aboriginal) health workers –trained locals who act as nursing assistants, interpreters and cultural aids. Services are limited, but with great variety. Most days we have at least 1 patient flown out to larger hospitals at Gove or Darwin for higher level care.

I have quickly discovered that initiative is the key to working out here. Unfortunately, initiative has been rather successfully bred out of me through Med school. But, as I bumble my way through doctor jobs, nursing jobs, cleaning jobs and other random jobs I am pleased to discover that while my initiative has atrophied, it is not completely dead. (-:

Men’s Health Sexpert
As the only male health worker here I have the privilege(?) of seeing any guys with ‘sensitive’ issues. This has necessitated me being quickly brought up to speed on the diagnosis, treatment and follow-up of sexually transmitted infections (STIs). It has also tested my inter-cultural communication skills as I’ve tried to counsel Yolnu blokes on STIs, condoms etc. Of course, I can always resort to a bit of footy-talk to break the ice before launching into the sex-talk!

Aboriginal Health
As you’re probably aware, the health of Aboriginal and Torres Strait Islander (ATSI) Australians is appalling. The current ATSI health crisis is unparalleled to any other developed country. With a segment of out population living in such 3rd world conditions, Australia draws better comparisons with developing countries such as India.

In the past decade, ATSI infant mortality rates have dropped somewhat, but ATSI kids are still 3 times more likely to die than non-ATSI kids! Meanwhile, adult health has actually worsened! ATSI Australians die more than 20 years earlier than the national average – and the gap is growing! Compared to other indigenous populations, such as the New Zealand Maoris, ATSI health is about 30 years behind. Compared to non-ATSI Australians, ATSI health is 100 years behind.

Yet despite the need, the Commonwealth spends less per capita on ATSI health compared to the rest of the Australian population – 74 cents spent on ATSI people for every $1 spent on non-ATSI people!?! According to a comprehensive report on ATSI health by the Australian Medical Association (AMA) in 2002, we know what to do and even have good plans – but simply lack the will to implement them.

But what do these statistics and numbers really mean to the people and communities themselves? Hopefully over coming weeks I’ll get some idea of the answers to that question. And I’ll eagerly share my discoveries and thoughts with you - watch this space.

The Yolnu People
The locals here are great value – very friendly and relaxed. I’m reveling in the waves and smiles I get from complete strangers throughout town. The joys of country life! English is a 3rd, 4th or 5th language for them – a Yolnu dialect being their 1st language. But despite this, most speak English quite well and I am keen to show my interest in learning Yolnu (a few words at least).

Already my limited understanding of their culture has convinced me that they are at least as different culturally from me to any community I’ve visited in India, SE Asia or Europe. I have much to learn! One early lesson has been regarding cultural aspects of death and funerals. You may know that the name of whomever has “passed on” will not be spoken, nor will pictures or other images be viewed. Furthermore, anyone who has the same name will change his or her name for a period of time (sometimes years). A funeral is currently proceeding, bringing up new cultural issues for me every day, and I am sure to discover much as it concludes over the next few days.

Plans
I’ve settled into the clinic routine remarkably quickly and look forward to immersing myself in the varied everyday medical experience out here. Other hopes and plans include:
· Visiting communities out in the Homelands
· Meeting the Traditional Land Owners
· Going bush – maybe even some hunting and fishing
· Playing basketball and footy with some local guys
· Lots of beach and swimming (though perhaps not with old croc)

5.3.05

PHOTOS - Thailand

There are now NINE albums available to view.

Just follow the link below. You need to sign up (if you haven't already) - but it's very simple.

http://www.yorkphoto.com/share/p=404121108228574426/l=42198992/cobrandOid=1002

Album 1 - Travel around central Thailand
1. The Three Pagodas Pass - less impressive than I imagined
2. Death Railway - of WW2 infamy
3. Bridge over River Kwae - site of many Allied and Thai deaths under Japanese in WW2
4. Slum river in Bangkok
5. A few northern Thai hill-tribe costumes6. House of Kittapong, my family's Compassion sponsor child
7. Kittapong and sister

Album 2 - Around Fang
1. Fang Hospital
2. My house3. Friends - SiKrai and Yui, meddies from Chiang Mai University
4. Friends at a karaoke house
5. Fang National Park Gardens
6. Gardens with hospital staff
7. Tribals displaying wares
8. Fang Hot Springs

Album 3 - Thaton
1. Thaton temple
2. Thaton temple view
3. Tribal selling wares at temple
4,5,6,7. Hilltribe village
8. View from river

Album 4 - Fang Hospital
1,2. Vaccinating kids at school for Polio
3,4,5,6. Operating room and op pics (appendix; thigh wound from MVA)
7,8. Emergency Dep - with thigh wound 'fresh'

Album 5 - Chiang Mai
1-7. Temples in Chiang Mai
8-10. Sunday Night Market

Album 6 - Around Fang
1,2,3 - farmland around Fang
4 - Fang temple
5 - creek in Fang
6 - Fang market
7,8 - Fang main street

Album 7 - Thailand + Burma + Laos
1 - Thai/Burma border
2,3 - Burmese market
4 - northermost tip of Thailand
5 - Golden Triangle
6 - Golden Triangle map
7-10 - Laos village

Album 8 - Trekking in Northern Thai Hill-tribe region

Album 9 - Community Health visit to Hill-tribe

ENJOY!

3.3.05

Thai Opus 5 - Finale

Monday, 21 February 2005

My adventure in Thailand has finally come to an end. However, I am forever changed by my experiences over the last couple of months. G.K. Chesterton wrote: “The whole object of travel is not to set foot on foreign land; it is at last to set foot on one’s own country as a foreign land”. I have certainly found this to be true!

I flew from Bangkok to Melbourne on Thursday Feb 17. I had returned earlier than planned to visit my dying Granny in Sydney. Unfortunately she passed away the day I returned, so am now in Sydney with all the family doing funeral-related activities.

However, it is not all mourning here – it is great to see all my cousins for the first time in years. And I realise why I love Sydney so much. I’m actually sitting in the shade of the Sydney Opera House writing this, shaded by its impossible peaked sails. I’ve just enjoyed a very posh lunch with my Publishers at a classy resturaunt at the Rocks. But, I’m ahead of myself – I should backtrack to Thailand.

Part I - Farewell Thailand
My last few weeks in Thailand were packed with activity. Of particular note were the visits to the Hilltribe communities – both as a tourist and as a health worker. This gave me two quite contrasting impressions, and a much better idea of the challenges such communities face.

My tourist experience came by way of a Trekking trip. I had signed up with a group in Chiang Mai and had been looking forward to this for weeks. It was to be a 3 day hike throughout the hills to the Northwest of Chiang Mai (near Mae Hong Son). [This is quite near to our family sponsor child Kittapong – see previous email]

I spent Saturday night in Chiang Mai, enjoying the night market and second-hand bookshops. Sunday morning I piled into a songtaew (like a flat tray ute with a cover) along with 9 other trekkers. After driving for a few hours we stopped at a village, before finally reaching the beginning of our hike. My trekking party consisted of: 2 German backpackers, an Israeli couple, a Taiwanese couple, a New Zealander, 2 UK backpackers and myself.

Our first night was spent in a Karen village. While my companions put up their feet and downed some Thai beer, I set out to explore the village. For the next few hours I used my limited Thai to talk with some of the villagers. They were really friendly, inviting me into their homes and chatting away. When I finally said goodbye one of the little girls gave me a flower (which I smuggled into Australia in my treasured journal). I am so glad I made the effort, and now regard them much more personally – it is impossible to dismiss them as a backward minority group of no consequence after playing, smiling and laughing with them and their children.

The following days involved more hiking, elephant riding and bamboo rafting. Northern Thailand is beautiful – rolling hills, rivers, waterfalls, bamboo forests, and village farms dotting the landscape. At night the skies are drenched in stars (though lacking the familiar Milky Way and Southern Cross).
On my final Saturday in Fang I headed off with the Community Health team to another Hilltribe village. Here we spent the morning immunizing children, and conducting family planning and basic medical consultations. The extent of these community visits is very limited. Only large villages in close proximity to Fang are visited, and even these visits are rare and provide only very basic care. Any villager who requires more than this must travel into Fang Hospital. Even then, I met no hospital staff who could speak any of the hilltribe languages so healthcare is often extremely veterinarian. There is certainly scope for much beneficial health outreach (particularly health education/promotion) among the hilltribes of northern Thailand.

On the whole, Thailand’s Hilltribes remain a largely forgotten peoples. In recent years Western interest (through tourism) has done much to bring them to attention. This has had many positive effects, as the government has needed to provide at least tolerable living conditions to secure the tourism dollar. However, there is much cultural vandalism occurring along the way.

Part II – Back to Australia
Goodbye Granny - As mentioned earlier, I’m back in Sydney now following the death of my lovely Granny. She lived in Malaysia for many years, where Papa worked in the rubber industry. My father grew up in Malaysia, so I feel a strong link to the area through this family heritage. Indeed, this is why I chose this area to visit. I am disappointed to be unable to share these experiences with her, as I know she followed my travels with interest. But I do hope to develop some of the love and charity she displayed in her own life.

Graduation Year – This year is my final year of MBBS (Bachelor of Medicine, Bachelor of Surgery). The past five years have really flown, though there has been plenty of hard work involved. This year I have seven 6 week rotations. I’ll be doing Emergency, General Medicine and General Surgery at Dandenong Hospital here in Melbourne. Then Aboriginal Community Medicine in the Northern Territory – living in an Indigenous community. The finish the year with Psychiatry and General Practice back here in Melbourne. Obviously, the NT placement is the one I am looking forward to with most anticipation!

Book Publication – As you may know I have a book being published. I met with my publishers in Sydney over a very expensive lunch. [I didn’t understand half of the words on the menu and kept thinking how extravagant it all was compared to Thailand] The book is titled Beyond Borders: McGraw-Hill’s Guide to Health Placements, and will be released by April. It is written for health students and professionals planning an intercultural health placement. So if you know any doctors, nurses, physiotherapists etc feel free to spread the word. If you’d like a copy ($19.95) or some promotional posters just let me know. All royalties will be donated to Medecins Sans Frontieres (Doctors Without Borders) – a large NGO Health Relief organisation which is involved with areas of need all over the world (http://www.msf.org.au)/. The book will be available through medical and general bookstores in Australia, New Zealand, UK, some parts of Asia and maybe the US. But it is a little book and will depend mostly on person to person promotion, so if you’re keen to help out let me know.

Family Matters – For those of you wondering what the rest of the Graham clan is up to, here’s a quick summary. Dad – working with Simplot in Devonport, Tasmania ensuring that you all get real potato in your McDonald fries. Mum – working with Temcare in Devonport helping families in crisis. Dylan – in Hobart working as a Builder for Fairbrothers. Serena – in Melbourne studying Chinese Medicine at RMIT and missing boyfriend Matty. Hannah – in Launceston (Tasmania) studying Nursing and serving up quality subs at Subway. Tristan – in Cochabamba, Bolivia on student exchange. Kinza – in Devonport studying Year 10 and dreaming of getting her motorbike license (death wish).

Signing Off
My time in Thailand has had a significant impact on me. My hospital experiences were much different to what I expected, but very beneficial. No doubt the impact of these last few months will take many more weeks to be fully revealed.

Thank you for sharing the journey with me, I hope you have enjoyed my tales.

2.2.05

Thai Opus 4 - Fang Hospital (with teeth)

Wednesday, 2 February 2005

I’m well into my fourth week at Fang Hospital – time is really flying. The last few weeks have been jam-packed with activity. I’ve had some amazing experiences here at Fang Hospital, and some very memorable trips around the area.

I’ve finally managed to post some of my pictures on the Web. I’ll try to keep adding albums as I go. There are presently FIVE albums on the web, visit the website below for access. You do need to sign up, but it is very easy. Also visit my Blog for updates.
www.yorkphoto.com/share/p=772291106997308381/l=41400905/cobrandOid=1002
www.adventureswithhamish.blogspot.com

This coming week I’ll be seeing lots more hospital action, going on a jungle trek, visiting some more hill-tribe villages before finally saying my good-byes and packing to come home. But first here goes for another update (I apologise in advance for the length and morbid content).

Thailand’s Health
Health in Thailand is a paradox. On one hand Thailand is definitely a ‘Developing’ country, with high child mortality and loads of preventable disease. On the other hand, Thailand has embraced development with vigor, resulting in a remarkably high number of doctors. Here are a few of my personal experiences with some of Thailand’s top current health concerns.

Roadkill
Last weekend I witnessed the worst results of road accident I’ve ever seen. The incident involved 2 motorbikes, 5 young male passengers, 0 helmets and an unknown quantity of alcohol. The first to guys were brought into ER in pretty bad shape. One had a deep leg laceration and nasty head wound – but was conscious and stable. The other was unconscious and barely breathing. His face was an absolute mess, with watery blood running from his nose and mouth and left leg broken in at least two places. He was intubated, stabilised and transferred to a neurosurgeon in Chiang Mai (3 hours south).

I met the remaining three victims at the morgue – their lifeless bodies displayed unceremoniously on stainless steel trolleys for the doctor to examine. The fluorescent light overhead gave their skin an eerie, unreal appearance and their fingers were stained blue from fingerprinting ink. Family members were ushered in to identify the dead. I cannot describe the look of loss, pain and total disbelief on their faces. As I joined the doctor to identify and record the injuries my mind spun as I tried to make sense of what I was seeing.

I’ve mentioned Thailand’s shocking ‘road-kill’ statistics, but this brought it home in a very real and personal way. Here is an excerpt from The Nation – an independent Bangkok newspaper:

EDITORIAL: ’Tis the season of carnage on the road (Jan 02, 2005)
http://www.nationmultimedia.com/2005/01/02/opinion/index.php?news=opinion_15948534.html
One is more likely to die in a road accident than from any other cause in Thailand… With 36 road deaths a day, Thailand ranks sixth in the world in relation to total population, according to the World Health Organisation.
With the high proportion of motorcycles on Thailand’s streets, 80 per cent of fatalities from road accidents involve these two-wheeled vehicles. But that’s not the end of the story… a percentage of these drivers will be under the influence of either alcohol, amphetamines, or perhaps even both.
It’s time the government and police started getting tougher on bad drivers, particularly drunken drivers, those who fail to put on their seat-belts and motorcyclists who decline to wear helmets… Irresponsible motorists must be treated like the potential killers that they actually are.

HIV/AIDS
As the biggest single health issue facing the world, HIV/AIDS gets a decent chunk of teaching time at Monash University. But it is here in Thailand that I have really seen the results of this indiscriminate killer for the first time. At present there are half a dozen patients with AIDS-related illness on the ward, and a large proportion of general patients have asymptomatic HIV infection.

I think of one girl in her mid twenties, suffering from Pneumocystis carinii pneumonia – a severe lung infection only seen in advanced AIDS. She lay before me, her wasted body buried in a pile of blankets. As her sunken eyes met mine I wished I could communicate with her – but what would I say? She is dying a slow and ugly death, I cannot begin to understand what she is going through. Another 25yo man is here with cerebral toxoplasmosis – an AIDS-associated brain infection. He has repetative muscle twitches and intermittent convulsions. He has improved somewhat and is due for discharge today – but he’ll be back, it’s just a matter of time. Another young woman presented with CMV retinitis – an AIDS-associated eye infection. She still somehow manages to look after her family and work, but is slowly going blind.

Here is an excerpt from an international AIDS charity on the present situation in Thailand:

AVERT - http://www.avert.org/aidsthai.htm
There are very few developing countries in the world where public policy has been effective in preventing the spread of HIV/AIDS on a national scale, but Thailand is an exception. Its well funded, politically supported and comprehensive prevention programmes have saved millions of lives, reducing the number of new HIV infections from 140,000 in 1991 to 21,000 in 2003. None the less, one-in-100 Thais in this country of 65 million people is infected with HIV, and AIDS has become the leading cause of death.
The first case of AIDS was reported in Thailand in 1984, and it is believed that widespread transmission began in the late 1980s. In 1988-89 in the first major wave of the epidemic, HIV infection exploded among injecting drug-users, rising from almost nil to 40% in a single year. At almost the same time, a second wave of infection spread among sex workers. The rising infection level among sex workers launched subsequent waves of the epidemic in the male clients of sex workers, their wives and partners, and their children.
It has been estimated that each year, up until the end of 2006, over 50,000 Thais will die from AIDS-related causes. Over 90% of these deaths will occur in people aged 20-44, the most productive sector of the workforce.

The campaign against AIDS involved: massive funding; a huge public information campaign; and the ‘100 percent condom program’ aimed at commercial sex establishments. This has had great success in reducing sexually transmitted HIV – the HIV infection rates in sex workers dropped from 50% in 1991 to 20% in 2001. However it has done little to reduce HIV in injecting drug users – with infection rates of 40-50%. HIV infection is rising among young people, presently at around 17%. Evidently, the problem will remain for some time yet.

Women’s Health
One of the most personally distressing cases I have witnessed here was a girl coming in after a ‘backyard abortion’. Like many other desperate women, she had illegally obtained a drug to prematurely empty her uterus. Now she was had presented to ER with bleeding, sepsis and emotionally shattered. She would need surgery to clear up the physical mess, antibiotics to stop infection, and would hopefully avoid being rendered infertile for life. As I saw the physical and mental torture this girl was going through, it really brought home why abortion must be legalized.

In Thailand legal abortion is restricted to cases of incest, rape or threat to the mother’s life. Yet, like anywhere else, abortions continue. These illegal abortions involve medical or physical evacuation of the uterus, with shocking physical and emotional consequences. In Thailand, one quarter of maternal deaths are due to complications of backyard abortions. In Burma, the stats are tenfold higher.

With these facts, I see no room for moral superiority in the debate on abortion legalisation. The focus must return to supporting a vulnerable and desperate woman as she makes one of the most difficult and distressing decisions of her life. Abortions will always occur, but society can choose whether to protect or persecute the women involved. It’s well and truly time that respect was returned to these women, allowing them to make the best moral decision for their individual circumstance.

Additional Highlights
Pandas – During a weekend visit to Chiang Mai I checked out the local zoo, including its key attraction – two beautiful Pandas. I still have a Panda teddy my Grandma made (which takes pride of place on my pillow), so it was great to see a live, breathing and bigger version in real life. Don’t worry, I didn’t try to cuddle it.

Wat Phrathat Doi Suthep – Overlooking Chiang Mai city is a magnificent Buddhist temple. During my religious exploration here I came across a Chinese fortune box of chopsticks. The chopstick I got was #9 (my favourite number), and I eagerly looked up its message- “The 9th number tells that you should not go away”. My next stop was a Meditation centre which advertised a 3 week short course for foreigners – the exact amount of time I had left at Fang! My excitement was quenched when I read the rules: no eating after noon, no ‘chatting’, no music and no reading!

Golden Triangle – A day trip to the Golden Triangle (of drug trade infamy) gave me the chance to visit 3 countries in one day: Thailand, Burma and Laos. I had lots of interesting experiences here, which were almost overshadowed by a scare with immigration. As a foreigner I was held up at the border to fill out paperwork. As I waited in line I realised that I was holding three bags full of my Thai friends ‘shopping’’ though I didn’t really now what was inside. It hit me that this would be the perfect way for my friend to smuggle in drugs. My imagination went nuts, especially as my friend had conveniently lost herself in the shops. I was honestly figuring out how best to spend my time in a Bangkok prison – would they allow books, music, writing letters? I knew my legal defense was pretty weak. I reached the official with beads of sweat on my forehead, looking anything but relaxed and innocent. But, I’m not writing this from my prison cell, so I evidently got through unscathed.

Conclusions
That’s it from me. I hope you have enjoyed another update. You can view them all online at www.hamishthailand.blogspot.com (and add comments too). Feel free to pass this on to others who are interested.

In love.
Hamish

Email: hamish_hammer_graham@hotmail.com

21.1.05

Thai Opus 3 - Two weeks in Fang

Friday, 21 January 2005

It's a warm afternoon here in Fang, and I have the afternoon free to relax. Today brings to completion the second week of my stay here in Fang and I have plenty of adventures to share.

I've met some great people here - who have been sooo generous in their welcome and hospitality. In fact, this weekend I'm off to Chiang Mai with some of these new-found friends - a bit of shopping, visit the Pandas and enjoy the sights of the city. I start regular village visits next week, definitely something I am looking forward to.

But here is another update.

Fang - where one earth?
A question I have been asked frequently since my arrival is "why did I choose Fang?". It's a fair enough question. Located in the far-north of Thailand, Fang cannot be found on most tourist maps - even Thai people rarely make it a travel destination. The general consensus is that there is simply not much to see. So, why did I choose Fang?

The People. Fang district has a population of around 150,000. Located around 100km north of Chiang Mai, Fang is in close proximity to borders with both Burma (Myanmar) and Laos. The population consists of an eclectic mix of Thai, Burmese (often refugees), Laos, Chinese and a variety of indigenous hill-tribes.

The Location. Northern Thailand boasts beautiful mountains and perfect weather. Just 15km from Fang is the Ang Khang National Park. Amongst the lush green mountains is a vast arboretum - with fruit trees, cacti, exotic plants, bonsai and thousands of flowering plants. Also nearby are the Mineral Hot Springs. Looking like a scene from another planet, with jets of steam spurting from black volcanic rocks, the landscape here is fully surreal. And if you can overcome the stench of sulphur the opportunity for a Mineral Bath is irresistible. Two hours north-east of Fang is Chiang Rai, and a bit further on is the famous Golden Triangle (my adventures here will no doubt find their way into my next letter).

The Hospital. Fang Hospital (where I am based) is the largest hospital in the District. It has 100 inpatient beds, and operating theatre, X-ray and ultrasound, a busy Emergency Department and an Outpatient Department that sees ~200 patients each day. There are 7 doctors here, including one Obstetrician/Gynaecologist. All the others are General Doctors (with varying experience) who attend to all ward, outpatient, emergency and surgical duties. Although this is an underequipped, understaffed, overworked health care centre by Australian standards, it manages all except the most serious emergency and surgical cases. There are also a few Thai medical students who do an amazing amount of procedural work - including C-sections and appendectomies unassisted! So it's the perfect opportunity to learn and practice clinical skills.

The Medical Cases. WARNING: SOME READERS MAY FIND THE FOLLOWING DISTURBING.
Obviously the caseload here is vastly different from Australian hospitals, but there are some similarities. Complications of smoking (e.g. lung cancer, COPD) are a big problem. This is only getting worse as tobacco companies switch their energy from "developed" countries (with growing restrictions) to "developing" countries (with easy, open markets). Trauma cases make up about half of Emergency admissions - most are from road accidents (not surprising). [Thailand has 20,000 road fatalities each year - and tens times more injuries. Road accidents cost Thailand 2% of the country's GDP!] One guy I saw had his entire right thigh shredded - skin, fat, muscle, nerves, the lot! Makes me reconsider getting a motorbike.

Firecrackers also do their damage - I assisted in the amputation of a 12yo boy's finger thanks to this. Animals are a threat - today I saw a boy with a monkey bite (the biggest concern here is the risk of rabies). Infectious diseases are common, especially with migrating populations from endemic areas (e.g. Burma).

One of my most enjoyable experiences so far has been a Polio vaccination drive. In one morning we visited a dozen local schools giving the oral vaccine (no big needles) to 500+ kids. I haven't seen much malaria, but plenty of tuberculosis and HIV/AIDS. Today I saw a skeleton of a women with awful oesophageal thrush due to advanced AIDS. Neglected medical conditions are also commonplace - including fractures, appendicitis, infected wounds, and end-stage organ failure.

So, with interesting people, great local attractions, a friendly hospital and mindblowing caseload - it's no surprise I chose to come to Fang!

Other Highlights
Food - Thai food is great. And thankfully eating is a national hobby. So there has been no shortage of rice, curry, noodles, sweets and other delicacies to experiment with. [Though there is a bit too much pork for my liking].

Karaoke - Perhaps second to Thai's love of food, is their love of Karaoke. It can be heard from houses and shops daily, is a must at any gathering (from birthday parties to professional conferences), and is the perfect conclusion to…well anything really. Fortunately I love music - but the destruction of talented artists good music by PopStar wannabees (myself included) does begin to wear thin after a few hours.

Kathoey - Some boys here in Thailand have feminine mannerisms and behaviour (like anywhere else really). While this would be undoubtably suppressed in mainstream Western culture, in Thailand it is actively encouraged - resulting in Kathoey, Thailands third sex. There are also a large number of gay couples living happy lives with the blessing and acceptance of society. Certainly something Australian mainstream society could benefit from!!

Tsunami - Much attention continues to focus on the relief effort and further preventative strategies. With 226,000 deceased - the concern now is for the 1,000,000 who have lost their livelihood with no prospect of recovery for years. At the Kobe Disaster Summit in Japan, interesting discussions have surfaced. One such topic raised is the issue of climate change (which US representatives immediately attempted to quash). Here are some expert comments:

Climate change is not a movie or science fiction development. It is calculable. It is already happening. (The result is) the short-term increase of extreme weather conditions. It is not only a quantitative increase. It is also a qualitative increase. The amplitude of those extreme weather conditions is higher. So we have more and more intensive storms, hurricanes and cyclones. We have more intensive flooding with very heavy raining. We have more intensive droughts.
Klaus Toepfer, executive director of the United Nations Environment Programme (UNEP)

It's childish. It's infantile to say if you don't name it doesn't exist. You cannot look at disaster risk reduction in the world today without looking at climate change.
Ben Wisner, hazards expert at London School of Economics

Conclusions
I'll sign off now. Hope you have enjoyed another update. You can view them all online at http://www.hamishthailand.blogspot.com/. Feel free to pass this on to others who are interested.

In love.
Hamish

Email: http://by103fd.bay103.hotmail.msn.com/cgi-bin/compose?mailto=1&msg=7C412622-85E1-4D8E-BDCB-4917820A8B07&start=0&len=10376&src=&type=x&to=hamish_hammer_graham@hotmail.com&cc=&bcc=&subject=&body=&curmbox=00000000-0000-0000-0000-000000000001&a=dab7afb5abe55ff3d3545f8437d60485

8.1.05

Thai Opus 2 - Bangkok to Chiangmai

Saturday, 8 January 2005

I’ve finally reached Fang – a small city 4 hours north of Chiangmai, very near the Burmese border. The morning is cool, and a moist mist envelops my cottage. In fact, I have even needed to drag out my jumper!

A great deal has happened in the last few weeks. I’ve travelled from Bangkok through central Thailand, across to the western border and now up to the far north. I’ve had some quality family time as we visited dozens of tourist sites, but finally said goodbye yesterday as the others departed for home. The next five weeks I’ll be spending here at Fang Hospital – hopefully seeing a bit of the surrounding hill-tribe communities as well.

So here goes for another quick update!

Kittapong – my sponsor brother
Child Sponsorship – “an artificial union between two vastly different individuals, families and communities that has the potential to produce lasting change”.

Like many Australians, my family and I are involved in child sponsorship. Aid organisations, such as World Vision, Compassion and CCF, strive to give a human face to their calls for contributions. They certainly seem to draw in the money, but I’ve always wondered about their true value. Are they simply a successful promotional tool or can they be something more?

Kittapong, my father’s 6yo sponsor son, is from a Karen village in the hills of Chiangmai province, Northern Thailand. Having been in contact with Compassion staff while in Australia, our arranged visit was to be one of the highlights of our time here. So, Wednesday morning we were up bright and early for a 7:30am start. [Unfortunately our first driver crashed his car on the way to get us, so we didn’t actually leave until 9am] It took almost 6 hours to reach the Compassion school Kittapong attended – winding up and down steep roads and bumping along pot-holed dirt tracks.

Climbing out of the car we were met by a handful of smiling Compassion staff and an anxious looking Kittapong clinging grimly to his mother’s neck. After a tour of the school and boarding houses we set off again to Kittapong’s village. Here we met his younger sister and a host of extended family members.

Kittapong and his family live in a three-roomed hut, mounted on wooden posts. The floor, roof and walls are made of bamboo and there is no electricity. Cooking is done over a fire pit in the corner of one room, the bathroom was “out bush”. With no furniture the floors were clear for working, playing and sleeping. A few clothes hung from one corner, but other possessions were not visible.

Mum pulled out a few gifts from Australia – pen, paper, toiletries, Tshirt, beanies etc. The children first reacted warily, then began curiously exploring these foreign trinkets. Kittapong’s mother helped pull a T-shirt over his head. As he stood to admire the Tasmanian Devil picture a big grin broke out. The first smile we had seen, sheer joy radiating from his face.

Unfortunately we all too soon had to leave. Having seen how treasured they hold our letters and photos; having heard how his family talk about his education, health and future; and having witnessed the joy our presence and a few small gifts can bring – I realise that child sponsorship is more than just a $400 transaction each year. And I will certainly be putting a little extra effort into my letters to my own sponsor child in the Philippines.

Travelling Highlights
Exchange Family – During 2002/03 my sister, Serena, went to Thailand as an exchange student. A few hours north of Bangkok is Ban Phraek, where she lived with her host parents, and sister, Mae. Having heard stories and seen photos it was a real thrill to actually meet them in the flesh. They toured us around the big attractions. Lop Buri - famous for its huge number of rogue monkeys, which are apparently led by a one-eyed dominant male. Ayuthaya – the ancient city ruins of a very wealthy empire. It also brought back many memories of my own time on exchange in the Slovak Republic (1998/99).

Moo Ban Dek "Children’s Village" – a morning stopover at a village orphanage school turned out to by a truly inspiring time. This is home to around 50 kids from six to sixteen years old. It is arranged in huts – each hut houses 12 –15 kids and two house-parents. During the day, house-parents double as teachers. It is run by children – they make decisions, farm, cook and purchase necessities. Interestingly, they do not have to DO anything – they are promised food, clothing and love regardless. School, work and chores are all a choice. Truly remarkable! Volunteers can come for stints of a year.

Death Railway – crossing Thailand into Burma, this infamous railway was constructed during World War II by Allied POWs and local labourers. The “Bridge over River Kwae”, in the city of Kanchanaburi, has been immortalised by book and film. Museums in Kanchanaburi pay homage to the events of this time and the many who lost their lives here. The Three Pagodas stands as a memorial up on the Thai Burma border, where the railway crossed over.

River Kwae Christian Hospital – also up near the Burmese border is this small but impressive hospital. It is run by Thai, Burmese and other local ethnic groups for the refugees and underpriviliged of the area. A few foreign volunteers are also involved in the work here. Particularly working with the intellectually and physically disabled. It would be a very interesting place for an elective.

Tsunami’s Wake – no doubt you’ve continued to hear updates regarding the Tsunami. It is encouraging to hear of the work of Aid NGOs, and the generosity of governments and individuals around the globe. Hopefully all these pledges will actually reach the local people in a tangible way.
I quote a comment from http://www.alertnet.org/:
“The most important question, however, is what role the region's governments, national and local, and non-governmental organisations and faith networks will be allowed to play. Only if they are at the centre of decision-making and spending will recovery efforts enhance local capacities and be sustainable.”
Here in Thailand, tourist resorts affected are reportedly back to 80% functionality. Of course, unlike the hundreds of local families, businesses and communities, the resorts have insurance!

Conclusions
That’s it from me. I hope you have enjoyed another update. You can view them all online at http://www.hamishthailand.blogspot.com/. Hopefully I’ll be able to put up photos here too.
Feel free to pass this on to others who are interested.

In love.
Hamish

Email: http://by103fd.bay103.hotmail.msn.com/cgi-bin/compose?mailto=1&msg=7C412622-85E1-4D8E-BDCB-4917820A8B07&start=0&len=10376&src=&type=x&to=hamish_hammer_graham@hotmail.com&cc=&bcc=&subject=&body=&curmbox=00000000-0000-0000-0000-000000000001&a=dab7afb5abe55ff3d3545f8437d60485