Photo for the Fridge

The official American Embassy photo of Hillary's visit to COPE. Putting this one on the fridge for sure. :)

It's raining frogs and bicycles

I've finally embraced the idea using a bicycle as my form of transport. Unfortunately, I made this decision right before our biggest rain storm of the year. So I'm a bit soggy in the shorts currently but happily so, as at least it's a welcome change from unrelenting heat.

The way I see it, having commuted via bicycle in Lao, I can do it anywhere. Don't get me wrong, the ride  isn't at all physically taxing, it's almost entirely flat and aside from the heat, you'd hardly break a sweat. Alas, its the rest of the people on the road in Lao that make biking a daily adventure.

I feel like I need to be decked out in combat gear every time I head down my driveway on my cute little  mountain bike. When I pull up a stop light surrounded by motorbikes, I can't help but feel a little like I should be revving my own engine. Instead I take a big inhale of exhaust fumes and try my best to stay out of every one's way.

However, Lao drivers haven't yet discovered the rear view mirror, with a mentality that only that which is in front of them matters. So I'm adopting a defensive biking method than entails holding on and praying I don't get rear ended.

I went to the gym today after work to go for a run. I went to the locker room and changed into my workout clothes and tennis shoes. I noticed one tennis shoe seemed to have a bit of a wrinkle in the foot orthotic. So I went and used the toilet and when the foot orthotic was still not right, I took of my shoe to readjust. I slipped my hand inside to smooth out the insole and felt a squishy, slippery little body. I screamed, jumped and tried to convince myself I wasn't hallucinating.

I peaked into the shoe and peaking back at me, looking a little dazed and smooshed was a substantial little frog. Poor little guy looked just as upset as I was, and I can only imagine how his poor little squishy body was feeling. So I took my little buddy outside and dumped in the rain. He didn't hop off to quickly but was gone when I left the gym an hour later.....so I hope he's tucked away in some little hiddyhole, somewhere recovering.

This little froggy was not so lucky as the one I encountered. Not a good substitute for padding in a prosthetic socket.

Hard at Work

Work has been good lately. The last few weeks, things have picked up quite a bit, and I feel like I'm getting to make much more of an impact.

Fitting a handmade Giv Mohr sling. The P&Os were really excited about the possibility of using this sling for the many stroke patients they see.

I held a training last week to train the staff in the fabrication of two new devices and the method of serial casting. There is a ton of work that goes into creating a five day training from scratch so it's nice to feel like it's worth it. I feel like I'm starting to bond a little bit with my Lao P&Os which makes it much more enjoyable.

The training was structured so that the first three days, I worked with the P&Os lecturing on diagnoses, theory, and fabrication. Then the last two days of the course, their bench technicians came and worked with the P&Os to actually fabricate the devices. The idea is that the P&Os will gain a better understanding if they have to teach it to someone else, and hopefully it will promote teamwork, which from what I've been told is a problem, especially in the provinces.

Fitting a handmade Pavlik Harness. This is less likely to be used often, due to the fact that babies are NOT normally tested for developmental dysplasia of the hip (DDH). We hope to change that by educating the midwives, as we have about clubfoot and the Ponseti method.

I really enjoyed the training, although it's quite exhausting to lecture for five days. Luckily, I only have to do it a couple times a year. This training taught the staff to make a Giv Mohr sling, which is an upper extremity device for patients after a stroke. It helps support a flaccid arm, improves balance, prevents shoulder subluxation, and helps with gait symmetry. They also learned about the Pavlik Harness, which is a device babies are fit with if their hips are not forming correctly. The difficult part of this is getting the doctors to diagnose the hip problem. Currently, babies aren't screened for it and I've already had a couple cases where older children get xrays and have obvious DDH. Past a certain age, this becomes a surgical issue and one that we don't have the capacity to deal with, no it goes untreated.

Aside from our training course, I've also had the chance to see a couple of patients over the last few weeks. That's always fun and makes me realize how much I miss that part of my profession. Most of the patients I've been seeing are children, which I really enjoy. Although many of them have a strong aversion to foreigners and scream bloody murder when I come in the room.

I have been following up with a little boy (6 months) who was born without patellas and with extreme laxity in both his knees. So whenever he fully extends them, they dislocate. It's pretty painful to watch, although he doesn't seem to experience any pain. I've been talking with an orthopod in the UK but am really unsure what I can do.

This was her at 6 months.

The latest idea is to put him in some very simple long leg braces without any joints that hold him in about 80 degrees of knee flexion. So he won't be constantly dislocating his knees. Then hopefully the orthopod visiting in Sept. can take a look and see if there is any surgery that can be done. Not a great success story but a super sweet little boy with great parents.

Now an active, intelligent two year old.

I also got to see an adorable little two year old girl, who was terrified of foreigners. She apparently suffered a bilateral brachial plexus injury at birth. Without any intervention, her right upper extremity has improved dramatically and she almost has full function, minus a couple of flexed fingers. On her left, however, she has a flaccid wrist and hand, a 20 degree elbow flexion contracture and limited motion of her shoulder.

She does quite well, making do with what she has. But I made her a low temperature WHO (wrist hand orthosis) to try and stabilize her left wrist so she can use that hand as a support for bi manual activities. She tolerated it surprisingly well and hopefully will follow-up with OT and I'll get to see how she's doing. She sure wasn't happy to have me around, but she definitely made my day! 

Elephant Tower

Sunday, we decided to get out of Vientiane briefly and find some reprieve in nature. We headed up to Ban Na, a little village north of Vientiane where there is an elephant tower. Supposedly, you can sleep overnight in the tower and potentially see elephants that come to visit the salt lick nearby.

Elephant Tower....no elephants in sight though.

CANNON BALL!!!!!!!!!!!!!

Sunbathing after a swim. Not quite Pe Ell though.

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Our Lao guide doing a flip....quite impressive.

The Lao guides must think we foreigners are ridiculous. They practically carry us across all the streams.

So serene.

We only went for a day trip and had been told by friends that the likelihood of seeing elephants is slim to none. So instead we went for a nice trek and swim. A couple cannon balls and some lounging in the sun, what better way to spend a Sunday.

The Little Things...

that make Laos what it is. It's really the small things that make living in Laos such an unique experience. Day to day life isn't so different from home but then a little thing will happen and you'll be reminded that you're living halfway around the world, in a communist country.

My friend reminded me of this when she was talking about her impending trip home to Australia. She has been in Laos off and on for four years and thus has more adapting to do when she heads home. From her experience, it's the lack of rules in Laos that make it hard to readjust to a more developed regimented lifestyle. I asked her to clarify what exactly she meant by rules and as she gave examples, I saw that these same things are things I'm slowly adapting to and which caused frustration in the beginning.

Lacking rules in Laos PDR
Traffic - especially if you're a motorbike, anything goes. No need to look behind you or check your rear view mirror, all that matters is what's in front of you, people behind you need to take care of themselves. Stop signs and red lights are more of a suggestion than a hard and fast rule. Use your own discretion and blame the foreigner ($$$) who plows into you if it comes to that. One way street or designating traffic to driving only on the right side of the road....well only when it's convenient. Going against traffic spices things up and is often much more handy. "Right of way" - I'm not quite sure what you're referring to with this statement, we just slowly inch forward until the other car lets us go. Gridlock - well I just kept inching and so did the other car....what can we do? Now we're stuck here and blocking the intersection. Bo Pen Nyang!

 Ques/Lines
We don't actually believe in lines here. You're never going to get on the bus, get served, see the doctor, bank teller, etc. if you just stand there waiting patiently. How ridiculous.


Work hours
This is a direct quote from one of the Lao employees "the day is really long so you don't want to work too hard early on. You have to spread it out over the whole day. Then from 3-4 pm at the end of the day you are really productive to show that you accomplished something today."
Work hours are also a suggestion 8-4, 9-3 what's the difference? We're just going to take a 2 hour lunch break anyway. As long as I'm physically at work, I'm working. Napping behind the desk is work as well. So is getting drunk over lunch and playing BeerLao checkers in the break room. Foreigners like the word "busy", if you tell them you're too busy they usually just leave you alone. I can be damn busy napping a lot of the time. Why would they put these plinths in the clinic room if they weren't intended for napping? I mean really.

Communism - then on the other hand....maybe there are rules, just different ones.

For living in a communist country, Laos often doesn't feel that way. Sure we have ridiculous amounts of paper work and "red" tape to get through before we can do anything, especially since we work directly with the government, but in day to day life one feels pretty free and doesn't see a lot of evidence of communism. Yes, everyone talks about being in the "party" and corruption is rampant, just notice all the BMWs in a country where the import tax on cars is 100%, and all high level government employees are appointment based on their status in the party rather than any actual qualifications, but aside from that.

However, the other day, a colleague was talking about this conference coming up ASEM (the asia-europe meeting) with a bunch of high level officials in November. Apparently, the Laos government is mandating that all homeless people be taken off the streets and kept in facilities (that are understaffed and ill equipped) until after the conference. People are forced to clean up their shops, homes, etc. Women required to dye there hair back to a natural Lao color (black) and where it in a traditional fashion with a traditionally long sihn.

Crazy when the true communist control comes out. Just a reminder in case I forgot where I was living.

Hillary Clinton visits COPE

Hillary greeting the director of the PMRC, MOH, COPE CEO and COPE program manager.

Waiting, waiting, waiting. We weren't allowed in the visitor's center so spent half an hour in the heat waiting for our photo opportunity.

Her she comes!

The official photo....hope it turns out okay.

Hillary Clinton had a whirlwind tour of Laos PDR today. She was apparently only in the country for a grand total of four hours but luckily, she deemed COPE worthy of a twenty minute slot. Who knew that I would need to fly halfway around the world to meet my own Secretary of State and have a photo-op of course.

The whole idea behind Hillary visiting COPE is to increase awareness about cluster bombs and the horrific and long lasting suffering they cause for innocent people. Hillary was given a tour by Soksai, our Laos visitor center staff and then by Kerryn Clarke, the program coordinator of COPE.  Both apparently went very well, she was very attentive and asked lots of questions.

She then went on to meet a landmine survivor who asked her to ban cluster bombs.

"I just want to ask that you ban cluster bombs. Because I was lucky and found COPE but lots of people don't have COPE and so they need your help." Peter Kim, a landmine survivor who lots both his hands and eye site three years ago on his 17th birthday when he picked up a UXO in the village where he lived.

After her visit with Peter Kim, she went on to sign the COPE visitor's book and pledge the US support.

"Thank you for all you do for so many and I pledge the United States will support COPE and the Lao people and government to overcome the legacies of the past. Best Wishes. Hillary Roddam Clinton"


She then joined us for the group photo after a brief greeting and chat.

And she's off to her next event, a meet and greet with the Embassy families.

Just another day in Laos PDR!!!!

Weekend Getaway

It was my good friend Kerryn's 30th birthday on Saturday, so a group of five of us went away for the weekend. We drove 3 hours to the north of Vientiane to a little Laos style house on an island that a friend of Kerryn owns. It was a wonderful weekend getaway with loads of card games, drinking and lounging. The island is absolutely beautiful and Sunday there were wonderful rain storms.

A friend of Kerryn's owns the island (it's quite a small island) and house with his Lao wife. It's a second home for them, so they rent it out for 350,000 kip a night (just under $50). It's a beautiful traditional Lao style home with a large veranda, two simple bedrooms, an outdoor Lao style kitchen and a western bathroom.

The pictures don't really do it justice but it was an amazing escape from Vientiane for the weekend.
 

Grabbing a coffee at Joma before hitting the road.

Driving in Laos is similar to a video game. There are so may motobikes, potholes, animals, children, etc. that you end up weaving and swerving constantly. It makes for stressful travel, luckily my housemate drove most of the way.

Crossing the river to our little island getaway. Note the crate of BeerLao and cooler of tasty snacks.

The arduous trek to our bungalow. In reality it was a two minute stroll through a beautifully lush tropical island.

The boat ride to the island. Not quite an optimally shaped boat for the purpose but it did the trick.

We weren't sure quite what to expect, but I think the house and island pleasantly surprised everyone.

Happy to have arrived. About time for a celebratory Pimm's and 7up....a new favorite drink.

Popping the champagne for Kerryn's 30th Birthday!!

Toasting Kerryn for 30 years of life!

Shish kebabs for dinner. Yum!

I got the job of chef/bbq master. Not my forte but I think I pulled it off quite well, given the kitchen I had to work with.

Sitting down to a tasty dinner.

The surroundings were amazing, even covered in clouds.

Vientiane doesn't have much in the way of greenery so this island was incredible.

The limestone castes are just amazing.

The Beer Lao wind chime was already there, we just added the birthday balloons.

Lazy Sunday lounging.

Some serious gaming going on.

A little frustration at our inability to get the tent back into it's container.

A pair of sweet little puppies who adopted us.

The caretaker's little girl. What a doll!

Corn shucking time.

Hard to believe this is where I live....I guess I don't get to see this part of it most days.