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