Life and Death - USA and Thailand



An Old Man Walking In Tahsang Village

In America the Federal budget disagreements continue with outrageous allegations being hurled by both sides making the possibility of compromise all that more remote.  It appears to me that the art of civil debate and social discourse has been lost to and in favor of the cheap alternatives of character assassination and the instant gratification of labeling your opponent.

Besides the strategy of "winning" an argument by out shouting those who disagree with you, the standard procedure seems to be sticking a nefarious label on those who disagree with you; with the objective being to completely discredit your opponent and diminish any of the facts that they contribute to the discussion.

Egged on by the media, the participants in our government do not seek and identify those areas where they agree or can compromise.  Rather they seek to focus on the areas where they disagree with each other and how they occupy a much higher moral ground than their opponents.  Establishing class or a racial basis to defend your position and to attack your opponent's positon seems to earn bonus points in the tawdry game being played out across this land.

A big component of US public spending is related to health care.  Medicare and the implementation of Obamacare have significant impact upon the quality of services to patients as well as the costs to taxpayers.  There has been some and undoubtedly there will be much more argument regarding the scope and costs related to these programs.

One of the great promises of the Internet, especially sites like Facebook, is the ability and opportunity for people of varying backgrounds and experiences to exchange information.  Through Facebook I am well aware that having left the USA to work and live in other countries I have developed very different views than most of the people that I grew up with.  That is OK and does not mean that they are "bad" or that I am "bad".  We just disagree - there is nothing wrong with that.  It is just a natural phenomenon of people reacting, experiencing unique lives and adapting to different environments.  Ideally we would all benefit from sharing and considering the diverse perspectives.

I am fortunate that I have friends on the Internet that I can disagree with.  The important thing is that we can communicate why we disagree and in the ensuing discussion provide information with which we can each reconsider our individual positions.  Most importantly, so far, we have been able to still respect each other. 

Recently on Facebook there was a posting of an article from the AARP which called on people to contact their representatives to vote "No" on Rep Paul Ryan's budget which according to them would "effectively end Medicare as we know it and put the health of millions of older Americans at risk."

Someone responded to the posting by stating "Along with Medicare cuts, Medicaid benefits will be denied long term nursing home care for seniors.  Middle class families as well as low income families rely on Medicaid to help them afford nursing home care for their parents ..."

I felt compelled to respond and posed the following question.  "Whatever happened to taking care of your family rather than putting them in homes?  It works in Thailand.  It used to work here."

A friend of mine pointed out the following life expectancies for Thai and American people - Thai Male - 71.4 years versus US Male - 76.08 years; Thai female - 76.08 years versus 81.5 years for US female.  My friend also made the comment that this is what happened with taking care of your family, they die earlier.

Personally I was surprised at how little difference there is in the life expectancies between Thailand and the USA.  Those of you who follow this blog may have read several entries that I have written on health care in Thailand.  In Thailand you can have world class health care if you know where to go and you are able to pay for it.  In general the sophistication of health care for the average Thai is not comparable to that available to the average American.  Facetiously I also remarked that I did not know the extent that Thai driving practices had on the lower life expectancies in Thailand.

I have written about seeing a local doctor and paying $13 for the office visit and medication that was dispensed.  Thirteen US dollars for a doctor visit and prescriptions is extremely cheap for most Americans however it is a burden for the vast majority of people in Isaan.  The ousted former Prime Minister of Thailand, Sinirat Thaksin, instituted a national health care program in Thailand for poor people.  Poor people register and receive a card from the government.  The card allows the person to pay a fee of 30 baht ($1.20 USD) for medicine.  However the program is limited only to payments for medicine and does not cover procedures, doctors, or hospitalization.  This program is one of the reasons that he remains popular with the poor people of Northeast Thailand; but that is a whole different story that I am not writing about today nor do I choose to write about.  Just as I do not appreciate foreigners telling me what we should do in our country, I will not be a foreigner telling people what they should do in their country - it just makes life easier and more pleasant for everyone.

I have been told and I have heard people tell my parents that they are very lucky to have a son like me and a daughter-in-law like Duang who will travel 8,000 miles to care for them.  It is very nice to receive such compliments but for Duang like all other children in Thailand these are very strange statements.  In Thailand children are expected and accept the responsibility to care for their older relatives in their advanced years.  Typically it is the youngest daughter who bears the responsibility but extenuating circumstances can change that.  Some grandchildren or even nieces or nephews will care for an elderly relative.  It is ingrained in the Lao Loum culture to care for the elderly.  It is the way that America cared for its elderly in the past.  It was a duty and a responsibility of the younger generations - a social compact that for many today no longer exists.

My parents often apologize for "messing up" my and Duang's life.  I tell them and I really mean it that we prefer to not be here but it is our duty as well as responsibility to take care of them.  They need us and we are capable of helping them.  We are able to ensure that they can remain in their home where they are most comfortable.  Putting them in a nursing home at this time would not improve the quality of their life in any way. As to "messing up our life" - this is our life.  Living back in the USA and taking care of my parents is not necessarily the life that we planned but it is the life that we have.  It is the life that we have to deal with as best we can.  It is a life that we still enjoy.

In the exchange over Facebook, another friend wrote "In Thailand I suspect there's a basic respect for the elderly, rather than a basic fear of being elderly that seems to permeate the stay-young-forever society we have." I very much agree with that statement.  In addition to the fear of being elderly, I believe that in America, the elderly are considered somewhat of an embarrassment and I suspect that for some people they are too painful reminders of the fate that awaits all of us.  In our materialistic society there is not much value in being old. Other than medical care we are not great consumers of goods and services.  We also do not pay a high amount of income taxes or contribute to payroll deductions such as Unemployment Insurance, Social Security Hospitalization Insurance, or Social Security Old Age programs.  To the contary we are consumers of the government entitlement programs.

In Isaan caring for elderly has religious conotations.  A person earns merit in the Buddhist religion by caring for those who can not care for themselves.  Earning merit in this lifetime assists a person to return in a higher status in their next life.

No matter the case of how we consider the old, the fact remains that:

Funeral Rites In Isaan

We will all die some day of something.

The only speculation exists is how we will die and when we will die.

When I contemplate life and death issues, be it in Isaan or the USA, I am often reminded of a wonderful quote from National Geographic contributor, Wade Davis, a renowned Canadian Anthropologist.  In his documentary series "Light At the End of the World" regarding the Buddhist attitude towards death ... "The Buddhists spend all their lives getting ready for a moment that we spend most of our lives pretending does not exist, which is the moment of our death".

In Isaan death is a milestone of life which is familiar to and accepted by all people from a very early age. The conclusion of this life, which for many has been very difficult, presents the hope as well as opportunity for a better and easier life in the future - another step towards eventual enlightenment.

As I witness the pain and suffering of people in the USA as they artificially struggle to delay the inevitable, I have pause to contemplate the best way to live and die.

In Isaan, death comes quicker and sooner due to a lack of money and facilities. Yes the expectancies show that; roughly five years sooner than in the USA.

However as I shared with my Facebook friends, in Thailand it is not about how long that you live; it is about how you live which really matters.

At what point should we allow ourselves or others to let go and conclude the suffering?

If a person wants to spend their money in a futile attempt to attain immortality, it is none of my business.  However if public funds, my tax dollars, are going to be spent in this quixotic quest to avoid death then I am involved by default.

There were allegations last year regarding Obamacare establishing "Death Panels".  I do not want a panel of bureaucrats determining what procedures and medicines that I will receive.  I want the freedom to determine what the extent of my healthcare will be even if it means that I may not receive certain procedures because I can not afford them.  However the practical determination of how public funds are to be spent is entirely justified and in my opinion - expected and a duty.

However if public funds are to be used to finance anyone's health care, I think that it is entirely reasonable to have limits upon procedures and medications dependent upon one's circumstances.  What may be deemed appropriate to save the life of a 35 year old person may not be calculated to be appropriate for a 90 year old person. To me it does not make financial sense to pay $93,000 for a new drug treatment regimen for prostate cancer that extends the life expectancy of a man by 4 months versus chemotherapy which extends it by 2 months.


Is it the best use of Medicare or other public funds to pay for colonoscopy examinations of 87 year old people? 

Discussing who should receive what treatments is repulsive, distasteful and best left to the people directly involved - the patient and the physician.  However when the treatments are paid for by public funds, that discussion needs to take place in a more public forum and especially from the perspective of what is best for the overall collective good.  It is dirty and nasty to boil a person's future down to actuary tables and calculated value, but this is what we invite when we subbrogate our freedom of health choices to the government.

People die 5 years younger in Thailand than in the USA but at what cost do Americans live those five extra years.  More importantly, what is the quality of those five extra years that Americans live?

We are all going to die of something some day; there is no denying or escaping this fate.

I would rather die earlier and be happy at the time of my death than to live longer and either be miserable or suffer for the additional years. 

How you choose to live out your final years is up to you ... until, in my opinion,  your choices are paid for with public funds.  At that time your choices no longer become strictly yours.

As I was taught - You can have anything that you want as long as YOU can pay for it.  When you expect others to pay your bills, you give up a great deal of your freedom.

A true indication of how mature and sophisticated a society we are will be demonstrated in how the issues of personal freedoms, personal responsibilities, social responsibities, ethics, morality, accountability and common sense are resolved in regards to health care in America.



Two Souls Departing In Isaan



Inspiration and Encouragement

"Duangchan and Family Planting Rice"

Often we are not aware or at least most likely to not fully appreciate the influence that we have upon others.  We go about our lives doing what pleases us or perhaps doing what we believe is expected of us.  Most likely our power and ability to inspire and to encourage others is not a factor especially in our day to day relationships with people outside of our immediate family and close circle of friends.  However we have the ability to influence people far removed from our intimate circle of people.

We can influence others in sharing our knowledge, our experiences, our opinions, offering feedback and by our actions.

I have been toying around but not entirely focused on developing a photo exposition of some of my work.  I have gotten to the point where I had decided upon a central theme; "Bent At The Waist, A Photography Exhibit of Lao Loum Rice Cultivation in Isaan", selected the photographs, developed a book specific to the exposition, and purchased 15 of the planned 18 mounted prints to be exhibited.  I had researched and developed a framing scheme for the selected works but I had held off purchasing the mats and frames.

"Duangchan and Family Planting Rice"

"Isaan Pas de Deux"

As part of developing the photography exposition I had posted a couple of the selected photos on the photo.net website for grading and critiques in the "Documentary" category.  A couple people indicated that they would be interested in seeing black and white versions of the submitted photographs.

Some people consider that documentary photography must only be in Black and White.  I consider my work to be documentary style photography in that my goal is to capture a real and true moment at a specific time; sort of like "If you had been there then, this what you could or should have seen".  As such, there is very little posing, imposed direction, or post process manipulation in my photographs.  However I do prefer to work in color for no other reason than the fact that color, to me, more accurately and more completely captures the specific moment.

I took the comments of the other photographers seriously and resubmitted the photographs in Black and White versions.  Surprisingly to me, the B&W versions of the photographs received about a 10% higher rating than the original color submittals.  I find the predisposition of people to prefer B&W for documentary photography interesting but not sufficient for me to alter my style.  However the book for my planned photography exposition will have Black and White versions of the selected photographs for the "purists".

Yesterday, almost one month after submitting a B&W version, I was inspired and encouraged by a person well outside of my family and friends.  My inspiration and motivation came from a person that I had never met, spoken to, or written to.  I was only familiar with his work from the photography website that I participate in, http://www.photo.net/.

Jon Peri is a prolific photographer based in Paris who specializes in portraits and nudes.  I have become very familiar with his work through Photo.net and greatly admire his photographs.  It is not that I want my photographs to look like his but that I appreciate the beauty, style, and the quality of his work.   His style is very distinctive which is a trait, which I believe, that every true artist strives for.

John took the time to critique the B&W version of  "Duangchan and Family Planting Rice" - "An expressive work, very well composed. The shadows reinforce the image well and I like your choice of black and white also, bravo."

I have received encouragement from family and friends in the past regarding my photography but in the case of family and friends, you never are comfortable with the motivation behind the praise and encouragement.  The perception that there is a need to protect or shield a person from disappointment often leads to false or at least slanted evaluations.  This is not to say that praise and encouragement from family and friends is not appreciated or welcomed.  It is just that often the basis and credibility of their feedback can be suspect.

Receiving feedback from a stranger may not be always as palatable as that from an acquaintance but it is more likely to be more honest.

Receiving positive feedback from a person who is a professional with a great deal of experience is also inspiring and encouraging.

I am now motivated to proceed with developing the photography exposition "Bent At The Waist, A Photography Exhibit of Lao Loum Rice Cultivation in Isaan" and bring it to a conclusion.  Now that I have shared this plan should also help to keep me motivated.

We all have knowledge, experience, and opens that if honestly shared can provide inspiration as well as encouragement.

Lately I have been dealing a great deal with the Veterans Administration, "VA", regarding medical benefits for my father.  I had read so many horror stories about the VA facilities and VA treatment of people that I was shocked at what we actually experienced.  The VA facilities that my Dad and I visit in New London and New Haven are first rate.  The VA people could not be any better - they are helpful, polite, competent, and seem to genuinely carry for their clients. So far we have not had to wait a minute beyond our appointment time to see a VA doctor.  The VA is telling my Dad all the things such as eyeglasses and hearing aid that he can get through them and they follow up on arranging for him to receive them.   I am extremely impressed and I have only one regret - I do not qualify for VA medical care.  My Dad and I make it a point to always let the VA people know how much we appreciate their work and what a good job that they are doing.

It is important to provide positive feedback to those around us.  It is just as important as negative feedback or complaining.

Positive feedback encourages good behaviors and reinforces our expectations of others.

Positive feedback can be inspiring as well as encouraging; a gift that costs nothing.

Positive feedback is another way that we have influence over those around us; influence to make a better environment for everyone.

It's Not the Same - Somethings are not the way they used to be

On occasion I have written about Duang's impressions on living in America as opposed to living back in Isaan.

The main focus of this blog, "Allen's World", until I returned to the United States two months ago was to share experiences and observations of an America expat living in foreign cultures.

Today I am writing about one of my impressions of  living back in my childhood home.

Last week, Mom pulled out a bag where she keeps the household loose change.  I immediately recognized the bag - it is the old canvas bank bag from Hartford National Bank and Trust Company, that I used when I was a newspaper boy for the "New London Day" newspaper.

Back in the late 1950s and up to mid 1960s, I was a newspaper carrier for the local newspaper.  The newspaper is still in existence and my parents still have it delivered to the house.  But so much has changed.

When I delivered the newspaper, customers paid $0.30 a week from which I received $0.08 a customer per week.  Most people gave me $0.05 a week in addition as a tip.  A couple people, my favorite customers, gave me $0.50 a week - a $0.20 tip; more than enough to buy a comic book!

Shortly after returning home from school, a small vehicle similar to a milk home delivery truck would stop at our house and throw out a bundle of newspapers.  I would collect the papers, count them to ensure that I had enough for my customers, and put them into my newspaper canvas shoulder bag.  I would then set off to deliver the papers around my neighborhood.  The afternoon newspaper was distributed throughout the area through a network of newspaper boys and girls.  I actually purchased my route from a family of girls who had lost interest.

Once a month, on a Saturday morning, the representative of the newspaper would come to my parent's home.  He would check my records and collect the money that was due the company.  Newspaper carriers had small ledger books where we listed our customers and kept track of their payments.  We did not track how much that they paid.  We merely filled in the box associated with their name and appropriate Friday date to indicate that they had paid.  The company representative was also a source of information about other routes that were available to be purchased.  I bought some routes and expanded my customer base over the years.  The representative, an honest broker, was able to put buyers and sellers together.  A few times a year the representative informed us of special events for the newspaper carriers - free "Newspaper Boy Picnic" at Ocean Beach Park, free tickets to a swim show at Waterford Speedway, and free tickets to some body's "Hurricane Hellcat Stunt Driving Show".  If necessary the representative would also review and discuss any complaints that the company had received regarding our service to our customers.  We were expected to keep our customers satisfied and we were held accountable for their satisfaction.

We were expected to deliver all of our newspapers by 4:30 P.M.  There were many days that I delivered newspapers in the rain and the coldest that I remember delivering papers was -3F (-16C).  Three weeks ago, I answered a call from the newspaper explaining that the paper would be delivered late because of "distribution problems due to the weather."  The night before had produced abot 1/4" of ice and snow on the roads.  But this blog is not about "reminisces by an "old" man of walking 3 miles to school in the snow when I was your age"  This blog is about change and some of what we have lost today.

I have written a few times about lessons that I have learned from my parents with the biggest lessons learned being "I could have anything that I wanted ... as long as I had the money to pay for it" and "If you want something bad enough, you will work for it and if you don't want to work for it, you don't need it".  These were great lessons to learn.  These were lessons that could be learned and most importantly, APPRECIATED, because I earned money as a paperboy.

What made me think about being a paperboy, or I guess today's more politically correct term "newspaper carrier", besides seeing my old money bag was receiving a phone call the other day from the newspaper.  No, they were not trying to get me back to deliver the newspapers for them.  It was an automated notice to subscribers that the cost of an eight week subscription was going up $0.64 due to increased fuel costs.

My parents like all other subscribers no longer pay weekly to a newspaper carrier.  They no longer pay for the newspapers that they had received.  Today people receive a bill in the mail for the newspapers that they will be receiving.  My parents send a check by mail to the newspaper and neither speak or even know who delivers their newspaper.

Today the newspaper is placed in a special plastic receptacle on the front steps of a home rather than placed between the storm door and door of the house.

Today most newspapers are delivered by someone who drives a car.

Today there are not 4th or 5th grade school children, that I am aware of, starting out in business by walking their neighborhoods delivering papers.

I view this as a great loss - a loss for the children as well as a loss for our society.

Back in the "old days" a child's first business experience typically came as a "newspaper carrier".  We learned the necessity of being organized and disciplined.  We learned the world would hold us accountable and responsible for our actions.  We started to develop the required skills to deal with people in an environment outside of our immediate family - the real world.  At an early age, newspaper carriers learned the value of maintaining accurate records, the importance of budgeting, the value of good manners, and the need to maintain good customer relations.

I learned all the above as a young paperboy long ago.  These were lessons that have served me all my life and I value up to this day.  Besides the invaluable lessons that I learned, being a newspaper boy allowed my to be more independent and to exercise my independence.   With the money that I earned and saved from my paper route, I was free to buy the things that I wanted.

To this day one of my fondest memories is saving up my earnings, going to Sears and Roebuck Store and buying an umbrella tent for $17.95.  There was a strong sense of pride and accomplishment in setting a goal, working towards the goal, and accomplishing the goal.  It was MINE.  I had EARNED it.

When I was unable to deliver newspapers, I made arrangements with my sister to deliver the papers for me.  I paid her for her time but being a young capitalist, I did not pay her 100% of my prorated profits for the day. I recognized that it was my and my responsibility alone to ensure that my customers got their newspaper despite my problems, issues, or choices for that day.  In the end it was good for her and good for me.  In the end it was negogiated between us.

Today I see very few children outside.  I do not see any children learning life and business lessons by delivering newspapers.

Today I perceive that there is a great deal of fear and concerns especially related to children.  Imagine having children today walking in the rain, walking in the snow, walking in the cold to deliver newspapers to houses and inside of apartment buildings.  Imagine of all the possibilities of what could happen to them. I suspect that too many people are imagining too many things.  In one of my favorite Ian Tyson songs he sings "Wishing don't make it so"  To paraphrase I say and may be after a couple of beers I wiould sing "Imagining doesn't make it true".  Today in my home town, I see parents picking up children at bus stops to drive them four or less blocks to their home.  Today there seems to be a great deal of fear for the safety of children.

Fear can be a cruel prison that we are often too willing confine ourselves to.  Fear can take away our freedom to grow, to experience, and to be happy.  Yes, there are issues related to children's safety, but the facts indicate that these are more concerns than they need to be fears.

In the days when we carried newspapers, we had fears - we were afraid that Russian planes would fly over us and drop atomic bombs.  But we were prepared - we practised ducking underneath our school desks when the air raid sirens went off.  I also knew that if an atomic bomb went off while I was outside that I should jump into and lay flat in a ditch.  It is all so funny now to think back at our "safety plans" for atomic attacks, but these plans allowed us to move on with our lives.  Moving on with our life is very important.  We only have a few years on this earth and much less time to prepare to fully experience and enjoy our time.

As children we were made aware that there were "bad" people who did "bad" things to people.  However we were also taught what to look out for and how we could avoid the "bad" people and situations where we could be hurt. While we were made aware of the concerns we were also empowered and given a sense of control for our well being when our parents or police were not around.  As we became older we recognized and accepted our responsibility to watch over the younger children that attended our school and walked home along our route; just as the older kids had done for us.

Today my perception is that children here are held back from developing into responsible, accountable, and content individuals - a sort of arrested development.  They are not expected, allowed or even given the tools or skills to solve their interpersonal problems.  They are not expected to entertain themselves.  They are held less accountable and responsible for their actions.  Many adults are too involved in the minor trials and tribulations of growing up.  The children are often shielded from the realities of life that they will undoubtedly encounter some day.  They will face the realities and challenges less prepared than they could be.

Sadly they have less opportunities to learn at an early age the lessons of owning and operating their own business albeit just a paper route.  They are denied the opportunity to take the first steps of financial independence and self reliance.

It's not the same - somethings are not the way they used to be; not in far away Isaan but here in my home town, my home state, and my home country.  Perhaps it may not seem to matter, but children in other countries, our competitors in the world market and power stage, are not growing up this way.  It is with these people that our children, as adults in their world, will have to compete and deal with.