Thursday, March 28, 2013

Motorcycle Day Trip to the Mountains

Believing if I could get up to some elevation I could escape the terrible smoke conditions here, at least for a little while.  My neighbor Dave invited me on a loop day trip that would take us north up into the near mountains and around the back side of Doi Suthep, our nearby mountain, and return to Chiang Mai from the south.
The smoke season arrives every year at this time and lasts until the first rain of the rainy season in about 6 more weeks.  Media reports mostly blame farmers for burning off rice stubble for the problem, but I recently discovered information that attributes only about 20% of the total smoke problem comes from agriculture and actually about 30% comes from Thai's  burning off undergrowth in the forests and in the mountains.

Evidence of forest burning is everywhere you go in the mountains and this sign says "no burning" right at a recent burn site!  Popular wisdom says that the reason for the forest destruction is that the ash encourages the growth of an expensive type of mushroom that the ethnic mountain tribes collect and sell. 

What we found is that at an elevation of 3500 feet, the smoke was almost as bad as down in the flatlands.

It seems such a shame that trying to propagate these mushrooms is endangering the health of the whole population.  Law prohibits burning, but either the authorities look the other way, or they cannot catch the fire starters.

The government has tried a new remedy by sending planes aloft spreading the chemical urea, then dropping dry ice crystals which is supposed to open a hole in the inversion layer so the smoke can escape up and away from being trapped at ground level.  This is similar to cloud seeding to make rain, but of course there are no clouds to seed.  Personally, I believe this effort is just a political ruse to make a show that the government is taking the issue seriously.

The trip was interesting in that we came across a couple stretches of actual cobblestone road and while trying to establish one road connecting to another route was some dirt biking through some very rough and dirt track.  You never know what you'll come across when traveling the back roads such as the very large excavation operation that was literally eating away a mountain which looked like some sort of mining operation.  Lots of water was being used and was draining down into holding ponds where it is pumped back up to a holding reservoir for reuse.
One thing Dave likes to see are the many reservoirs scattered around the mountain valleys and it's always a nice break in the ride to stop and take a rest at these places.  The conservation of water resources is very important because growing rice takes a lot and the dry season is long and, well, dry.  I keep forgetting to take a bathing suit to take full advantage of these refreshing oases.
Back closer to civilization we came across this small river that provided rafting adventures for lots of foreign young people.  There was a small open-air restaurant at the side of the road and rows of lounging platforms down a hundred feet or so on the river for tourists to enjoy the cool waters.  Baskets attached to guy wires would send down food orders to the relaxing guests.  Not a bad way to pass an afternoon.
We passed many elephant camps where shows and elephant riding is available.  Also passed a snake farm, alligator farm, butterfly farm, ATV off-road adventures, bungee jumping, and zip line adventures.  All these activities really capture the younger backpacker crowd that supports so much of Thailand's tourist industry.
As for the smoke, I'll continue to wear my surgical mask until I can see the golden gleam of the temple at the top of Doi Suthep mountain again.

Tuesday, March 26, 2013

Medical Followup

To start with, I am feeling very much better now and my appetite has returned.  I've gained a pound and a half in two weeks and no longer feel faint when getting up from a crouch.  That's the good news.

Yesterday was the day to get follow-up lab tests so that they could be read today with my visit to the doctor.

Starting out early about 7 AM thinking I would be in the first 100 to get a blood draw, I arrived to see a jambed-up waiting mob at the entrance to the lab.  Lots of prone folks on gurneys and wheelchairs were waiting for blood draws.  My assumption is that they don't draw blood in your hospital room.  You have to be wheeled down to the lab for that.  Seems inefficient to me.

After I paid for my tests I approached the line trying to peer over the mob into the lab.  There were people standing inside and the non-ambulatory patients were getting their needle jabs at the entrance and blocking the entrance.  As I was looking, a Thai woman pointed that I should go around the corner, which I guessed must be another entrance.  Yes, indeed, the walk-ins used this door, but the crowd was lined up outside.  From my previous visit I remembered that you put your paperwork into a basket (face down, so when they take the stack out and turn it upside down they are facing up and in order of placement).  I squeezed my way in to the basket and deposited my paperwork.

Within minutes my name was being called and my vials were being dispensed from the automatic machine.  I was about to ask how the line worked when an attendant took me by the arm and escorted me right to the next phlebotomist, effectively cutting directly to the front of the line.  I didn't protest, but I felt very guilty although no one seemed to notice.  Later I deduced, or rather convinced myself, that because I am a "self-pay" patient and not on the government healthcare system, the hospital must "upgrade the money people".

So... my doctor visit this morning was an enlightening experience in light of my ranting how great the Thai healthcare system is.  Several of the tests were not complete from yesterday and on top of that the test for parasites was not returned at all from two weeks ago.  I have to assume I had parasites because I improved just days after completing the antiparasitic meds.

We went over all the readings that were available and she (Dr. Kanatta) reduced the strength of a couple and also promised to email me with the results of the rest of the tests.  She wrote new prescriptions for me, made another appointment 3 months out and sent me on my way.

I paid for my meds (I won't say how many), but I can say that in the US with medical insurance my co-pay was about $60.  Today's bill for everything including the doctor visit was $36.  Quite a savings.

In passing we discussed the smokey air problem here.  I can't see the Doi Suthep Wat at the top of our mountain any more, or even the mountain itself that is practically right at my doorstep.  I see a lot of people wearing surgical masks and asked her what she thought of that practice.  She replied without hesitation "I recommend it".  I countered with "but air can get in all around the edges", to which she replied, "a little protection is better than none".  I will wear one while outside or driving the moto until I can see Doi Suthep Wat again.

Tuesday, March 19, 2013

Four Day Motorcycle Tour of Northern Thailand

What started out as an overnight trip enjoyably evolved into four days in Northern Thailand.  My new Honda motorbike, freshly serviced, was ready for anything the road had to offer and so was I.

My traveling companions were my friends Dave and Nut who live in my apartment building.  Dave is from Alaska and has taken up mapping as a hobby and the reason for this trip was to map and identify roads that are not on any map and/or mismarked.  The Thai people are little concerned with road numbers or maps and it has fallen to us obsessive Americans (and others) to name and correct and add roads to the mapping system.  After all it is to our benefit if we want to travel about and to know where we are going and how to get there.  It is my assumption that Thai's don't care about this because they don't travel for exploration.  Their world is limited to their own neighborhoods and getting the business done of getting fruits and vegetables to the nearest market.  Who cares what the names of the roads are, right?

Dave uses his handheld GPS mounted on his motorcycle to trace his progress through a particular route.  As he rides, he takes pictures of road signs, highway markers, gas stations, and other useful roadside features for the traveler.  He then overlays his route on an "open source" map and makes necessary changes and additions such as "paved", "divided road", etc.  For more on open source mapping see:

Nut is Dave's Thai partner (always called "girlfriend" in Thailand) and is a funny, upbeat, no-nonsense Thai woman.  She is a valuable member of the mapping team able to translate signage, directions, and interact with the Thai people along the way to ask questions and get information about how to get places.  Nut is especially good at ordering Thai food and we always had a variety of really good Thai dishes delivered to our dining tables along the way at very cheap prices.

Our daily progress was always broken by rest stops, coffee shops, snack stops.  This is a coffee shop in the foothills going North from Chiang Mai over a mountain pass.

These mountain roads are exactly what motorcycles were made for!  It is so much fun banking into curves and accelerating out of them in the cool elevated forests.  Too bad I am new to motorcycling, but retirement opens new doors!

We passed many different and beautiful things like this waterfall.

Of particular interest to me was the abundance of agriculture in every open space.  I suppose this catches my eye because I come from the Central Valley in California where agriculture is king. 

Let's see how many commercially grown things I can remember:  Probably the most ubiquitous are the teak trees.  They grow wild and are farmed in groves and even interplanted with other crops.  There are many teak wood houses around always built up on pilings which are beautiful to see.  Bamboo is another common sight here.  It is always the "clumping" kind and large in diameter.  It looks as if it sometimes grows wild, but I saw a plantation of clumps all lined up in rows, so I assume it is a commodity of value.  It is used for scaffolding, branch propping, fences, ladders, and a wide variety of baskets, furniture, and even woven to make mats and used as house siding in poor areas of the forest villages.  The clumps are so dense that it must be difficult to harvest.  Of course rice paddies are everywhere and have several seasons because I see newly planted paddies, mature fields, and cut rice stocks.  Mango plantations are everywhere as well.   Papaya trees were not as plentiful on our trip, but they are seen anywhere people live.  It appears they grow in hard dry ground and almost every house will have at least one tree in the yard. Since green papayas are the main ingredient in the popular salad Som Tom, (which combines the flavors of sweet, salty, sour, and hot) they must be commercially grown elsewhere. Pineapples grow well here.  Many are a smaller variety than we see in the states (from Hawaii), but just as sweet and juicy.  We saw a huge tea plantation which I always assumed only grew at elevation, but this one was only in the foothills.  Bananas and coconuts grow in abundance and make the place look very tropical.  We passed several rubber tree plantations which look like it takes several years of growth before they can be tapped.  Of course there were some things I could not identify, but as I become more integrated into the culture I'll find out more.


Tuesday, March 12, 2013

Seeing the Doctor

After waiting my turn to see the doctor, he took a medical history and noted the medications I take.  The only physical exam involved a listen to my lungs and a look down my throat with a $2 flashlight.  None of those fancy gadgets we pay so much for in the states.  In fact the office was very minimal, nothing on the walls, and just a desk, computer and exam table.

He ordered a couple blood tests and stool exam and I was out of his office and on my way to first pay for the tests, then get the tests done.  The bill for seeing the doctor and getting the tests was less than $30.  The testing was very efficient.  You present your paid receipt with the ordered tests and an attendant inputs the information into his computer and an automated machine spits out a tray with 2 vials and a specimen cup.  You wait in the queue for your turn to get the blood draw.  All very efficient.  I was sent to a bathroom to give the stool sample and placed it on a tray at "window 8".

My instructions were to return room 10 in an hour and a half when test results should be completed.  I sat in a cool breezeway near a small bakery on the grounds and ate most of an apple smoothie and a muffin, read my magazine and went back upstairs to room 10.

The nurse at the reception desk sent me directly to another numbered room for test results.  When my turn came, it was a different doctor and she spoke very good English, but apologized for her weak language skills.  She called up the results on her computer, but they were incomplete and she explained that waiting longer would not be necessary because it could take hours more if there was a backlog.

She went over my symptoms with me again and suggested I might be afflicted with parasites and that one test result showed anemia.  She did another cursory physical exam (and used an identical $2 flashlight to look down my throat) and suggested we treat for parasites and anemia right away.  When I told her I had lost 9 kilograms in two months, she looked more concerned and ordered another blood test and urine to be done in a followup visit two weeks hence.

I paid the $1.50 for the two meds (apparently her visit was included in the original service charge), I picked up the meds at the pharmacy counter and went home to rest after a long day at the government hospital.

To date, I have finished the parasite regimen and there is no change.  We'll read test results in two weeks and I'll take her my lab test results I had done in Maine in November to compare.

Monday, March 11, 2013

A Visit to the Hospital (and Burma)

My appetite has been low since arriving in Thailand 2 months ago.  I've lost 20 pounds and the thought of food still does not interest me although I normally love Thai food.  I have reverted to eating mostly western food I am comfortable with and have to force myself at that.  Figuring something in my system must be out of whack I decided to make a visit to the doctor to see what's up.

Thailand has two medical systems and both provide good care.  One is the private hospital that costs more, but one can be seen very quickly.  The other is a Government hospital which is cheaper, but it is the system all Thai's use and is therefore overcrowded and has slow service.  Doctors don't have private offices here, so for any visit to a doctor one goes to a hospital of which there are several in Chiang Mai

I chose to go to the government hospital for a couple reasons.  One is that it is less expensive and the other reason is that I am not too sick to stand in lines and sit for periods waiting.  I want to experience Thailand as the Thai's do and I got my money's worth with this experience.  Although as I create this post, I await a follow-up visit to go over test results in two weeks.

I arrived about 9:30 on a Wednesday and was immediately overwhelmed with the number of people waiting in chairs and milling around.  All signage is in Thai (and there were a lot of signs with obvious instructions), but after asking around it became clear where one registers and gets a picture taken.  I notice little things like small birds flying around in the lobby, people on gurneys with intravenous drips being wheeled through the waiting area, and numbers being called out in Thai.  I have to confess I haven't even learned my numbers yet.  Next is waiting to approach the window where they direct outpatients depending on the reason you are there.  There were 100 numbers ahead of me so I waited about an hour and a half.  Luckily the calling of numbers was accompanied with a number sign board and Thai numbers are expressed in the numerals I am familiar with. When I arrived at the window, I was directed to another window where the counter person spoke passable English.  There was not another foreigner in the whole place of at least a thousand people.  Thai's have a social medicine system and many were going to the government insurance windows.  My English speaking fellow was apologetic in saying "I'm so sorry, but there are 300 people ahead of you".  "If you could come back around 5 PM we may be able to get you in to see a doctor".  I asked if I could make an appointment for Friday morning because I had to travel to Burma on Thursday to get my tourist visa validated for the second two month permission to stay.  "Yes, come on Friday at 7 AM to my window".  "That's when I come to work", he said.

So on Thursday morning at 8 AM I boarded a 10 passenger van that would take me and 8 other farangs (foreigners) to Mai Sai and the boarder crossing to Burma.  The trip is about 4 hours each way with a 15 minute rest stop and an hour to get the visa business done.  One walks to the Thai exit building to get your passport stamped for leaving Thailand.  Then you walk across a bridge to the Burma side and get your passport stamped for entry into Burma.  Then you walk back across the bridge to the Thai side and get stamped back into Thailand.  The whole process takes about half an hour, then you wait for your van to return to the drop off point for boarding and the fast and furious ride back through the mountains past Chiang Rai and home about dark.  An exhausting day considering the van driver was in a hurry tossing passengers to and fro through the mountain pass.

Back to the hospital on Friday morning at 7 AM.  I wait at my designated window and the office opened at 7, but my English speaking fellow does not show.  A little worried, I went to the other window and pushed my way to the front of a long line and asked "Man not come today"?, pointing to my designated window.  She replied "Not come till 7:30".  Sure enough at 7:30 he comes in and immediately sends me to the 3rd floor "room 10".  When I find room 10 there are two long lines leading to another counter so of course I get into the shortest one.  Soon thereafter I realise I am in a line that has no one at the counter.  Calming myself thinking I should just follow what the Thai's are doing I see that the counter person is taking papers from one line, then the other.  Soon a second nurse showed up to handle my line and within 45 minutes I am handing my papers to the nurse, getting my blood pressure taken and given number 95.  She said "come back at 11", so I drove home to rest for a few hours and returned at 11.  Being the only farang had it's advantages because when I approached the nurse, she immediately remembered me and called me by name "Mr. Daniel, go wait in line for room 5".  As I wait for 3 people ahead of me to see the doctor in room 5 I take the time to see what's going on around me.  Still no farangs... all Thai.  Men all cross their legs "like a woman would in America", no macho leg crossing posturing here!  Everyone is quiet and just waiting.  Nobody is reading or doing any other thing except sitting patiently.  I have brought a magazine and am happy to have something to do.

Next Post: Seeing the Doctor