Lost in Translation

This week is my first full five day training course. I've been co-training with Ilona, the PT, and a volunteer PT named Inge. The first day went well. I got my stride with speaking and lecturing again, especially with having a pace and time for translation. Takes a little getting used to.

Ilona and I hard at work. I think we're watching a patient walk and critiqueing the AFO he's wearing.



The problem came when Tuesday morning, I was informed by two colleagues of mine, that the Lao staff in our course had reported that my translator doesn't make any sense. They are interested in the information I was giving but my translator was not translating properly. Of course, I have no idea what is being said in Lao and didn't have a clue that my words were being lost.



Lao staff working with their new camera to capture some gait video of a stroke patient.



My translator, Soksai, and I at the team building day. He's leaving me to take over management of the visitor's center, so we're highering a replacement.

My colleague Donna told me the story of a Lao translator being asked to translate the term "mainstream" and saying then the man stood in the river. I can only imagine what my trainees have been being told.

Just yet another element that keeps this job interesting. Hopefully, yesterday and today went better. I tried to emphasize the need for the trainees to speak up if something doesn't make sense, because I have no way of knowing.

Our training has been on gait evaluation. A huge topic to cram into a week long course but they seem engaged at least. We've been having them do lots of demonstrations of gait and interaction which seems to help the learning when language is hard.

The Lao staff figuring out their new cameras. Lao culture seems to involve lots of standing around.

We've also provided them all with new laptops (each center gets one) and cameras to aid in gait evaluation and recording of patient gait and photos. One issue in Lao is that items such as these mysteriously disappear....never to be seen again.

Our COPE team building day. Normally I hate this kind of thing, but it was helpful for me to get to know some of the Lao staff better and understand the way the organization works.  



Training in full force. I'm enjoying the lecturing part of it but it's frustrating when it seems that so much is lost in translation.



Sweet babies and little braces

This last week, I've spent a large amount of time in our pediatric clinic. It's a difficult situation because we don't currently have a trained pediatrician or anyone with more than basic pediatric training. So, by default, we as foreigners are given the task of diagnoses. Which, being that we aren't doctors, we aren't really trained to handle, but we do the best we can given our knowledge base.

We had a patient come in who has something called arthrogryposis, a rare musculoskeletal disorder. The baby was born with contractures of most of her joints (meaning they are stuck in one position), and limited ability to move at all. She's now 10 months old and progressively improving although way behind normal development. Working with Donna, our pediatric OT, I made the little girl a pavlik brace from scratch to try and improve the positioning of her hips and some hand orthoses to try and stretch out her wrist contractures.

It's been fun working with a patients again and this sweet little baby is the most relaxed, easygoing child I've ever met. She is just as happy as can be and hardly ever cries or screams. Even when I'm tying her up in various contraptions. Her parents are obviously very devoted as well, and while the outcome isn't terribly bright, we're all hoping for the best.

It's hard to see how difficult disability is in developing nations. Most of our patience can hardly afford to come to our clinic despite the fact that COPE pays for transportation, food, and accommodation for the patient and a caregiver. They can't afford to be away from work and often only make it to the clinic once, never to return for follow-up.

We did our best to convince these parents that they needed to return in 2 months to check the progress of their little girl.

COPE Kittens...oh my

 COPE has a couple of cats that adopted us. They have a pretty good life, hanging out at the COPE visitors centre, bumming food and snuggles where they can. Recently, the beloved Bombi (named after a UXO) gave birth to four snuggly little kittens. She did this in a little loft about the COPE visitors center. So, of course, we've all been sneaking away on a regular basis to get some kitten time. I'm so very tempted to steal one and take it home. Ollie may not appreciate this news but maybe he doesn't need to know.

 The only issue is that when I leave Lao, what happens to my adopted feline friend? I do have a veterinarian for a housemate so maybe she would take over kitty duty. I'm not quite sure yet, but I'm leaning toward adopting a new snuggly friend. I guess it just goes to show how much I miss sweet little Ollie.

 Here I am doing some serial casting for a woman with severe wrist and hand contractures. I have tried to convince the Lao staff to take my lead and take over her care, but they seem hesitant. Not sure if that's because they are unsure of how to do it or if they just don't want any more work. I'm still trying to figure out how to read and communicate with them.

This poor woman has some of the most deformed hands I'm ever seen and she's very young. She has a diagnoses of some kind of syndrome but the visiting orthopod doesn't seem to think it lines up with her presentation. Anyway, not many surgical options. Arthrodesis of the fingers in a functional position. Patient refused this so we're keeping casting and try to get as functional as possible. Oh the joys of Laos.

Adjusting

This week has been fairly uneventful. I've been working a ton, as projects keep piling up. The nice thing is that there are lots of deadlines so at least procrastination is kept to a minimum.

Currently I'm finishing up the curriculum for a gait evaluation course I'm co-teaching with our PT, Ilona. The course isn't for another week or so but everything has to be translated into Lao...which of course takes time. I'm also writing up a couple of research studies we're going to try to do before we host the ISPO conference in Sept. The idea is that some of the Laos staff could present the results about current Clubfoot treatment in Laos. The hard part is getting the Laos staff excited and motivated about research. It looks like I will likely be doing most of the work and hopefully getting some cooperation with data collection, etc. Thankfully we don't have a Committee for Human Research in Laos...so things should go a bit faster than they ever did at UCSF. Get some government stamps and go for it.

We are also starting a remodel of the P&O workspace. This means for the month of April we're shutting the space down...as part of that I'm attempting to alter the work flow of the P&O lab to make things run more smoothly and have some rhyme and reason. I'm still trying to get someone to pin down their current practice for me. No actually seems to know how or why things happen the way they do. Quite the project!

Along with the work flow plan, I'm also hoping to reorganize the physical space, tools, work benches etc. and update their forms....and provide training on how to use them (which I'm sure they received at some point but have long forgotten).

Needless to say, April is going to be  busy month for me. Plus, we have the Laos new year called Pi Mai mid-April which means that no one does any work for at least a week or two. Officially we get three days off but apparently all the Laos staff takes a couple weeks. I'm planning a trip to Siem Reap, Cambodia...although now there are rumors of a beach holiday, so who knows. Either way, a getaway to see some other amazing parts of SE Asia. I also booked a flight to Sri Lanka in June to meet up with Garrett. So I'll get the beach holiday one way or the other. The astonishing part for me is that flying to Sri Lanka was half the price of flying to Cambodia.

Chiang Mai

Offerings at the Buddhist temple.

My friend, Kerryn, and I left work Wed. at 4:30 to make the trek across the Laos/Thai border over to Udon Thani to catch our flight to Chiang Mai for a long holiday weekend!

Chiang Mai is a popular tourist spot in Northern Thailand. It was once a city state and has an interesting layout from once having been a walled city. There is a square moat and remnants of a wall that once encircled the city. Now it's a tourist mecca, boasting lots of great shopping, spas, and beautiful buddhist temples.

Our Beautiful hotel.

The infamous Wall

We stayed at a fancy hotel with a nice swimming pool and all the luxuries that a good holiday requires.

Day 1 we spent touring an amazing Buddhist temple. They had these great caves built into the hillside, a sweet little lake with fish and pigeons that were used to handouts and some fantastic Buddhist quotes posted on all the trees.

I still don't understand why Buddhist temples are often so ornate.

Do you see the bat?

Day 2 we spent 3 hours at a fantastic spa being massaged, exfoliated, and generally pampered. We then visited a local ceramic store for some cheap purchases, made our way to a recommended tourist spot on the river for dinner and ended up in "Reggae Alley" for some Thai Reggae music. The Thai Reggae was really interesting. One of the bands we saw was decked out in Bob Marleyesque attire and you couldn't understand a word they said. Imagine a Thai accent trying to sing with a Jamaican accent....gets confusing real quick. The second band was a group of young guys, looking like Thai Beattles in skinny jeans. They were actually great though. Singing lots of popular Reggae and Ska and with a light enough accent to be understood well. It was great to see some live music and explore the new found genre of Thai Reggae!

Day 3 we spent way too long in the Thai Mall shopping for things you can't find in Lao, like quality clothing, haircuts, and small electronics. The afternoon was spent lounging by the pool, reading, and generally relaxing. We then hit up the infamous weekend walking market for trinkets and gifts.

Day 4 I struggled to recover for a long night of food poisoning in order to travel home. Luckily, the travel was relatively painless and I made it in one piece....still recovering though. Makes it hard to appreciate such a wonderful holiday when you return feeling so crummy but it was a great trip all in all.

Hot Hot Hot

It's heating up in Laos....a scorching 95 degrees today!!!!

Good thing I'm headed to Chiang Mai for the weekend....not that it's any cooler there but at least our fancy hotel has a pool!!!!! Woohoo!!!! 4 day weekend of pool lounging, napping, reading, shopping and eating tasty Thai foods. I'll be sure to play the tourist part and take lots of photos. Hopefully we'll make it to a yoga class or two as well. Maybe a run also.....seeing as how I ran my first mile since "the injury". Granted it was on a treadmill but I figure I'm well on my way. It's so nice to be able to get some exercise again. I've been doing yoga but my cardio has been nonexistant.

Ian has even inspired me and I'm thinking I can make some kind of running goal for when I get back to the US (running outside in Laos, can you say heatstroke!). He's been throwing around the idea of a marathon. Not sure I'm that ambitious but something along that same vein. We'll see. It would at least help with motivation to get to the gym. Of course, when it's the height of hot season, I'll probably go there just for the AC.

Other than the sweltering temps, life in Laos is going well. I've been meeting a ton of Americans lately, which has it's pros and cons. I met a couple last night from Santa Cruz, who were lamenting the lack of good mexican food in Laos (Garrett close your ears). The guy grew up in Seattle and when I told him I was from Winlock, he came up with the fact that it's near Toledo....I love when the world feels small.

That has been by far one the best things about my adventure so far. Meeting lots of great people. People with different perspectives on the world. Meeting lots of people from different countries and getting outside the small American view. Oh and the fruit. I've been living on tasty papaya, mango, watermelon, etc.

Xieng Khuang

Seven hours on a minibus on some of the roughest, curviest, and worst maintained roads I have ever seen. But we all survived and none of the 12 passengers vomited. So we'll call it a great success.

We booked a minibus from Luang Prabang to Xieng Khuang rather than a normal bus, because I was told it's much better. Let's just say I wouldn't want to experience the normal bus version. The minibus is basically a large minivan crammed to the brim with luggage and 12 passengers. Luckily I snagged a seat by the window in the second row and downed my dramamine well before take off.

The roads in Lao are often only partially sealed meaning that just when you nod off, the van hits a rough patch and your shaken awake as your head rattles against the window. Makes for a long seven hours when sleeping isn't an option. The scenery , however, is amazing. Beautiful mountains with lush green foliage for as far as the eye can see (which isn't terribly far due to pollution). The road winds it's way up and down through the mountains meandering through villages. The minibus driver blares the horn regularly to warn children, pigs, and water buffalo. It's frightening how many toddlers you see wandering along the side of the road, sometimes accompanied by parents or siblings, but just as often not.

Because the mountains are so steep and the foliage so thick, all the villages we see are built as close to the road as possible, perched precariously on the steep edges. The result is a village, it's people and animals, living on top of a dusty road. Not quite optimal, if you ask me.

COPE newsletter

Check out COPE's March newsletter. It's a pretty cool organization I work for!!!


http://www.copelaos.org/web_files/file/COPE_News_march_2012.pdf

Luang Prabang day 2

Me and my Lao coworkers finishing off our tasty meal with some beerlao.

The longer I'm here, the less I want to leave. Except I would quickly go broke buying things. Work finished at noon today and I spent my afternoon shopping and exploring the city. There are so so so many beautiful handicrafts here it's hard to resist. Luckily, I have limited space so I mostly stuck with things easy to carry like jewelry, clothing, and a couple gifts, mostly for the families lastest addition, Kyne Taylor Eldred (did I spell that right?).

Hard at work at the Luang Prabang workshop.

Bamboo foot bridge!

10,000 kip ($1.20) buffett, in an alley off the night market!