Thursday, November 21, 2013

Dying In Isaan - The End of Days

WARNING:  This blog contains images that some people may find disturbing or perhaps offensive.  The photographs of death are documentation of the rituals and customs of the ethnic Lao people of Northeast Thailand.  These photographs were taken at the request of my wife and with the acceptance of the family.  I was not alone in taking photographs of this nature.  The intent in sharing the photographs and observations of the rituals is to describe a culture that many people may not be familiar with.

Duang's 76 year old father has been dying since July.  A lifelong smoker and a heavy drinker, he had been in ill health for a long time.  But it was in July that his health deterioration accelerated.

He had been hospitalized several times only to be released to return to his home.  I do not know what his diagnosis was but according to Duang "his insides no good"  Upon pressing her further as to what was wrong with her father, she said that she had seen and x-ray and one of her father's lings had "too much white inside".  It seems that her father had lung cancer.  Given his history of smoking, it seems to be a reasonable assumption.

The preceding anecdote give a glimpse into the state of health care for the majority of people here in Isaan.  Patients and their family are not fully informed of the condition or alternative treatments - much like US health care was in the 1950s - "The doctor knows all and knows best.  Details will only confuse the patient and people"

There is a stereotypical belief that "Life is cheap" in Asia.   I have not seen evidence of that during the seven years that I have been in Southeast Asia.  To the contrary, I have witnessed the love, care, and nurturing of the people for each other.

The Buddhist attitude towards death is best expressed by Wade Davis, a renowned Canadian Anthropologist and contributor to several National Geographic documentaries, in his documentary series "Light At the End of the World" ... "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

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

As I witness the pain and suffering of people in the West as they artificially struggle at great costs; emotional, suffering, and monetary, to delay the inevitable, I often give pause to contemplate the best way to live and die.  Here in Isaan, death comes quicker due to a lack of money and facilities. Surgery and chemotherapy were not considered to be an option for Duang's father due to concerns over quality of life issues, a lack of financial resources, and a rather accepting attitude towards the inevitability of death.  At what point should we allow ourselves or others to let go and conclude the suffering?  For me, accepting the inevitability of death and deciding to not needlessly prolong it does not constitute devaluing life let alone causing life to become cheap.  The care, love, and respect that was given to Duang's father in his final days indicated to me that his life was in no way considered to be cheap rather it was cherished and respected.

Duang's father went back into the hospital on Monday 18th November.  He had not been eating for a few days and was prepared for his death.  He went to the hospital because he had difficulty breathing and wanted to die at the hospital.  He was admitted into the Intensive Care Unit at the Kumphawapi Hospital.  Duang was given a list of items to purchase for the care of her father in the ICU.  Here in Thailand at the smaller hospitals where the local people go for care, family and friends are responsible for the non-medical car of the patients.  Family and friends bathe, dress, and change bed linens for the patient.  They also are responsible for assisting the patients to the bathroom, emptying bed pans and urine collection bags.

Duang returned from the hospital Monday night with her son and his wife.  She said that her father was on oxygen and that they would give him blood transfusions in the morning.  Tests had been performed, family members screened and identified as blood donors for the morning.  He then would be released to return home after being examined by the lead doctor.  Duang's son and his wife stayed at our home since it would be an early wake-up in the morning.

At 6:00 A.M., our daughter-in-law knocked on our bedroom door.  She had gotten a phone call from the family in the village informing her that Duang's father had been taken off of oxygen and would be sent home after the hospital doctor had examined him.  Duang, her son and his wife left immediately.  Duang requested that I drive out to either the hospital or the village after I had showered, shaved and eaten breakfast.

Duang later called me to inform me that her father had returned to his home in Tahsang Village.  After the one hour drive, I arrived at the village around 10:00 A.M. to participate in the death watch.

Death watch in Isaan

Arrived at Duang's parents home to find her father laying upon a makeshift bed on the tile floor in the main room of the house surrounded by family members.  His hands laid in his lap clutching a wad of baht, Thai currency.  The money was given to him for the journey that he was about to undertake.  The money along with other offerings will be cremated with him.

There was a very strained atmosphere in the room.  People were tense awaiting the inevitable. Many of the people had tears in their eyes but every one was reserved as well as in control of their emotions.  There was no sobbing or audible crying.  There was a great deal of caring, concern, and tenderness.  Duang's father was still alive but seemed to be comatose.

As the youngest daughter, Duang is responsible for taking care of her parents.  As such, she took the lead during the death watch and for all the activities that occur after the death.  I was amazed and proud at her strength, tenderness and dignity - not that I did not expect it.  However one does not really know exactly how they or any one will perform when confronted with extremely difficult challenges until they actually occur.

Duang speaking to her father

A great focus of the death watch was determining if the person had died.  Duang periodically placed her finger under her father's nose in an attempt to determine if he was still breathing.  At other times she would touch his arm or his forehead.  Her older brother also did the same.  Other family members would arrive and touch Duang's father and speak to him - pretty much saying "good bye and good luck to you".  Duang also spoke to her father in an attempt to determine if he was still alive.  She also was asking him to stay alive until her son, his oldest grandchild, had returned to the home.  Duang's son had driven off to pickup up one of his cousins to participate in the death watch.  It seems that in the ethnic Lao culture it is important to witness the death of a loved one.  Unfortunately Duang's son was not present at the time of his grandfather's death.  From Duang I learned that her son was very upset but he expressed his grief in private.

I had never been a part of a death watch before.  Just as in America where popular culture makes such a daunting and intimidating spectacle of witnessing child birth for men, I was conditioned to be apprehensive about witnessing the death of a person.  I witnessed the birth of my first son to support my wife who was far from home and family.  After seeing and reading so many stories of men passing out when women gave birth, I was concerned that rather than supporting my wife in her time of need, I would cause her concern or create problems for others.  Well witnessing the birth was nothing like what is commonly portrayed in the media.  It was fascinating.  It was interesting.  It was watching a miracle - nothing upsetting, disturbing, or cause to pass out.  I was so pleased that I took advantage to witness that event.  I looked forward to the birth of my second son.  Having experienced the first birth, I knew that there was nothing to be afraid of.  Faced with the challenge of a death watch for the first time I approached the ritual  with the same attitude of wanting to support my wife in her time of need and with the same degree of trepidation as I had regarding witnessing child birth.

Duang and her oldest brother attend to their father

When confronted with challenges, most people will perform as is necessary to support others and to do what is necessary.  Once again I realized that during the death watch.  Here in Isaan most people die at home.  There is no doctor, no Medical Examiner, or Police in attendance at the passing of a person in the home.  Family members are responsible for the process.  After about an hour, it became apparent to me that Duang and others were having difficulty determining if her father had died.  I asked if any one had a compact - a small mirror that we could place under his nose to see if it would fog up from his breathing.  After explaining
exactly what I was talking about, I realized that no one had one.  I checked his pulse on his wrist and on his neck but could not find one.  I was not certain that I had done it correctly.  I then realized that I had in my hands something that could determine if he was still alive - my camera's speedlight (flash).  I asked Duang to open her father's eye and I fired the flash at his face.  She did not see his eye react to the light.  We repeated the test and there was still no reaction.  I then opened one eye, stared deeply into it and fired the flash a third time.  His pale grey eye did not react at all.  The pupil did not change size at all and I felt like I was staring into nothingness.  I released the eyelid and told Duang that he was dead.

The death watch was over. After the pronouncing his death, three fusillades of fire crackers were set off to scare away and drive off any bad spirits in the area.  The Village headman was summoned to the home to record the passing and to document the death.

The death watch was over.  It had been dignified.  It had not been revolting or disgusting. It was nothing to be in fear of once it had been experienced.  The desire to support loved ones had gotten me through experiencing it for the first time.

The tension in the atmosphere immediately disappeared. People who seemed somewhat paralyzed by the watch process and its uncertainties now sprung into action.  Several woman gathered his clothing and personal belongings.  After selecting his clothing for his cremation, the remaining clothing was placed into two cardboard boxes and each box secured with string.  These items will be burned in an open fire when he is cremated on Friday.

Aunts prepare Sai Sein

Some of the older aunts sat down with cotton string similar to butcher's string, "Sai Sein".  This string is fundamental to religious rituals here in Isaan.  Pieces are tied on the wrists of people in Bai Sii Kwan rituals, rituals to ensure that the 32 internal spirits necessary health, wealth and good luck are bond to a person's body.  Baii Sii Kwan ceremonies are performed at many events including weddings, illnesses, New Year celebrations, retirement parties, prior to a big journey, and to honor dignitaries and guests.  Vehicles and motorbikes have hunks of sai sein wrapped and tied around their steering columns for protection.  A thick and long rope like sai sein connects the coffin to the procession of Monks leading the funeral cortege from the home to the local Wat for cremation.  During the funeral ritual at the Wat, a thin sai sein connects the coffin, and by proximity the deceased person's spirit, to the Monks in the nearby Bot.

The aunts were preparing pieces of sai sein to be used in preparing the body to be placed in the coffin. They paid particular attention to ensuring that each piece of the sai seins had a predetermined number of strands.

After washing, baby powder is placed on the body

Duang's son and to of his cousins took the lead in carrying the body into the nearby bathroom for washing.  There was a crush of people, both male and female, into the bathroom.  The clothing was removed from the body and the body carefully placed on the floor of the shower with the young men holding the torso upright.  People pressed to get into the room for the opportunity to have dish washing detergent poured on their hand to then wash the body.  The detachable shower head was used to rinse the body.  The young men then moved the body into the adjacent kitchen area where it was dried.  Prior to dressing the body in the selected clothing for cremation, people placed baby powder on the body - just as people do to babies and children every day.

After the body was dressed it was placed on a saht and thick blanket on the tiled floor.  Three face clothes were placed over the face of the body.  After a while someone came with a section of undyed muslin cloth - a sort or shroud.  The body was lifted up and the cloth was placed underneath it with a great deal of conversation and discussion as well as two adjustments to get it placed correctly.  There was a great deal of conversation in the room as if the people's grief was being transformed into verbal communication.  It seemed to give the people a positive focus and to keep their minds active rather than lapsing into morbidity.  There was a great deal to be done and the people were fully engaged in getting it done.

The shroud and all the shrouds that I have seen here did not completely cover the body.  The cloth was about one meter (one yard) wide and when the sides were pulled towards each other did not completely cover the entire body.  The arms and hands were re-positioned so that the hands were in the "wai" (praying) position. In addition to the paper currency that was in Duang's father's hands, some green leaves were added and held in place with a piece of sai sein.  Other sai sein were used to bind the feet, the legs and to bind the shroud to the body.  I believe the leaves are an offering that is a reminder of the temporary nature of all things and in particular - this life.

Securing the shroud and binding the hands
Duang and her son went off into Kumphawapi to commence making arrangements for the upcoming four days - four days of ritual, and feeding guests concluding on Friday with the cremation.  Their first task was to purchase a consumable coffin, arrange for the delivery and rental of a refrigerated coffin, and commence buying food, soft drinks, and liquor for all the guests who would be arriving over the four days.

After the shroud was secured, the body was completely covered with heavy blankets.  Particular attention was made to ensure that the body was completely covered.  I kept a vigil over the body with the other men.  The women divided themselves into two groups.  One group occupied themselves cleaning the house and outside area.  The other group occupied themselves slicing, dicing and chopping vegetables in preparation for cooking.  A large plastic tub was filled with water and about 50 pounds of sticky rice was poured into it to soak prior to steaming later in the day.

Everyone was busy.  They all seemed to know what to do.

When Duang returned with the consumable coffin, one of the aunts sprinkled the plastic liner with baby powder.  The body was then placed inside of the coffin by the men - again with a great deal of animation and conversation.

Since Duang arrived from her side trip to the market, there were huge bags of vegetables, mushrooms, and other food items to be washed and prepared.  Magically the man who goes around selling charcoal stoves (five gallon sized refractory lined containers) had arrived earlier and the family had purchased five of them to cook the meals for the upcoming days.  These stoves were quickly filled with wood along with charcoal and fired up.

Later the man with the refrigerated coffin arrived, a problem was discovered.  The refrigerated coffin would not fit through the doors of the house.  Where there is a will there is a way but it does help to have a hammer.  Several men took turns with a claw hammer to beat out one side of the door and some of the thin cinder block wall that it was attached to.  In time the access was created and the ensuing mess cleaned up.

The refrigerated coffin was wheeled into the room where the body was located in the consumable coffin.  After a couple shots of lavender room freshener spray into the refrigerated coffin. the consumable coffin was placed inside with the body going in feet first.  The man from the rental company then set up a stand to display a photograph of Duang's father and brought in several tribute items - cardboard artificial flower displays with clocks and freshly printed personal messages from donors.  After the cremation the clocks are offered to the Monks.  I asked Duang what the Monks did with all the clocks that they get.  She said that they sometimes give them to other Monks who don't have a clock.  I noticed all three of the clocks read 10:20 when the actual time was 2:30.  I told Duang to tell the man they we should get a discount because the clocks did not work.  She told the man and every one had a good laugh.  Laughing?  Laughing when someone had just died?  Yes that is the way it is here and in this culture.  Actually the laughing had started earlier in the morning and at my expense.  Duang's father had just died.  One of his sisters said to everyone that her dead brother looked like me.  They all laughed like crazy.  I touched her skin which is very thin and wrinkled as I then touched her brother's arm.  I had Duang translate "I look like a dead man?  Look your skin is much worse than his skin"  Everyone, including her. enjoyed another good laugh.

Death here is familiar.  It is a recognized part of life.  Death is experienced in the open and not hidden from view or restricted.  One of the great grandchildren, a three year old girl, witnessed the entire process.  She was not afraid and seemed curious as to what was going on.  I was concerned about our grandson, Peelawat, who lives with Duang's parents and his mother.  He was at school for the day and was returning at 4:00 P.M..  I had talked to Duang about ensuring that he understood what had happened, what was going on, and what would happen.  I did not want him to be afraid let alone traumatized by events.

Duang and I had discussed the situation of her father's death long ago.  When her father died I knew that she would have many duties and responsibilities which would require her to stay in the village.  We agreed that she would stay in her parent's home while I would stay at our home.  Too many people drinking and making too much noise get to me along with the more primitive comforts of the family home.  I told Duang that I would do what she needed me to do to support and help her.  Actually my absence actually makes things easier for her - she does not have to worry about me, feel obligated to take care of me, or take time away from family and friends to explain things to me.  She asked me to stay until Peelawat came home from school.  Later the plan evolved into me staying until he came home from school, Duang, Peelawat, and I would then go to our home to get clothes and essentials for Duang to stay at the village, I would eat foreign food, and we all would return for 6:00 P.M. when the Monks would arrive to perform the first night ritual.

Peelawat arrived home and seemed somewhat surprised or bewildered by all that was going on.  He came into the large room and stared at the refrigerated coffin, the floral arrangements, the tributes suspended from the exposed ceiling beams, the large stick of incense burning, the large lit candle, and the flashing Christmas type lights on top of the coffin and around his great grandfather's photo. Duang calmly explained to him what had happened.  He went to his room and quickly returned wearing his regular clothes rather than his school uniform.  He went to Duang and he paid his respects to his great grandfather.

Great Grandson, Peelawat, lights incense to offer to the spirit of his Great Grandfather

Afterwards on our way back to our home with Peelawat, I asked Duang about if Peelawat understood what had happened and what was going on.  She said that Peelawat was fine and was not afraid.  She had explained to him and he told her that he understood and had known other people who had died before.

Peelawat, almost 5 years old, makes an offering and pays respect
We returned to Tahsang Village in time to participate in the ritual with seven Monks - Duang's uncle who is an Abbott and highly revered Monk in the area, Monks from "Inside" Wat and "Outside" Wat.  The ritual seemed to be a typical merit making ritual that I have witnessed countless times here in Thailand.

Duang's uncle, an Abbott, pours water over the food that she will offer as nourishment to her father's spirit
As part of the ritual a tray of food was offered by Duang to nourish her father's spirit.  After chanting by both laypeople and the Monks, her uncle a very senior Monk poured water over the food which Duang then placed underneath her father's photograph next to his coffin.

After the ritual I returned home after a very eventful day - one of several sure to come during the remainder of this week.

As I drove the one hour back to our home, I could not help reflecting about life and death amongst the ethnic Lao people of Isaan.  I have always been impressed with the sense of family and community that I observed at Lao Loum funerals over my time here in Isaan. After experiencing the final hour of life and preparations for a funeral, I am even more impressed and in admiration of the culture.

On a personal note, I am more familiar with death now than I was ten years ago.  Death holds much less mystic over me. We learn much from each other.  I have been taught a great deal and learned much from my wife and her culture.  I am thankful and I believe I am better prepared for the  future.


  1. well told and sensitive account

  2. Thank you Tom. I was not sure how many people would perceive such a piece but I did want to share an alternative culture and attitude regarding death with others who have not had the opportunity. I am happy that it worked for you.