Isaan Alternative Medicine

Shaman Applies First Treatment to Duang

Living here in Isaan provides me with many unique experiences and interesting opportunities.

"Allen's World" is a more spiritual world than the world that I lived in prior to coming here to Isaan.  When I write the word "spiritual" I am not using the connotation of Judeo-Christian beliefs, or Judeo-Christian practices.  The spiritual nature of "Allen's World" is the beliefs and practices of a belief system that predates the birth of the major religions of our time.  Here in Isaan and in particular, my wife and the other ethnic Lao people, is a strong faith and fear of the Animist faith.  Animism is the belief in spirits and their power to affect every aspect of our daily lives - for good and for bad.  The commitment to Animism is that it has survived the arrival of Hinduism and subsequent  arrival of Buddhism to the area.  Rather than eliminating the Animist beliefs and practices, the Hindu and Buddhist faiths tolerated and often incorporated the indigenous Animism into their system.

Animist believes provide answers to all questions great and small as well as solutions for all problems.  It binds the community and provides reassurance as well as stability to the ethnic Lao society.

A large part of the Animist faith deals with matters of health.  Ceremonies are often held to ensure that the 32 spirits required in one's body to ensure good health and good fortune are bound to the body to ensure that they can not escape.  These ceremonies are also performed to bring missing spirits back to a person's body.  The ritual involves making offerings to the spirits, invoking their help through chanting, and tying short pieces of string around a person's wrists to bind the spirits.

A Shaman Treats Peelawat's  Blood Infection

 When our grandson was just a toddler he developed a blood infection in his foot.  The family brought him to the local hospital in Kumphawapi for treatment.  Peelawat was given intravenous fluids and antibiotics to fight the infection. The family also summoned the local shaman to come to the hospital to treat Peelawat.  The shaman came to the hospital and proceeded unabated to treat Peelawat.  His treatment involved examining the foot, chanting, saying some prayers and spraying the affected area with red betel nut chewing saliva from his mouth.  Peelawat instinctively understood what was going on and pointed several of his other "boo-boos" to the shaman for treatment.  The shaman smiled but did not feel it was necessary to treat those old injuries.

Duang spent last week end in Tahsang Village, taking care of Peelawat while her mother was in Laos on a religious retreat in Vientiane.  We had discussed it and agreed that it would be best for Peelawat to remain at his home with all his friends that to spend the weekend with us.  Duang returned Sunday night to our home Sunday night with a very runny nose, very tired, and with a sore throat - all of which we attributed to her stay out in the village.

Monday she was still sick with what we believed to be a bad cold.  That evening we went into town for a great meal with an old friend and a new friend who were on their way to Laos from the USA.  We went to bed around 11:00 PM with Duang complaining about having pain in her abdomen and pain in her back.  She also indicated that she was hot, as in burning, inside and outside at specific locations on her torso.  She had great difficulty sleep and at 03:00 she went to the Emergency Room at the Military Hospital three quarters of a mile from our home.

Duang was diagnosed with shingles, herpes zoster, by the doctor.  She returned home with five different medicines to take and an appointment to return to the doctor in seven days.  The next morning, Tuesday January 21st, as is my habit whenever we get medicine, I went on the Internet to determine just exactly what were the medications as well as what are the treatments for shingles.

From the Internet I determined that Duang was to take antivirals for shingles.  Duang had told me that she had like a snake inside of her that would spread and if it had completely encircled her she would die. In questioning her the previous night about the condition she told me that she had gotten it from food in the village.  I had immediately though of liver flukes from unpasteurized pla daak (fermented fish  - 6 months minimum). I was definitely confused and was preparing to go back to the hospital and find someone who could explain to me in English what was going on.  By the time that I finished my research on the Internet, Duang's condition had developed to the point that I could see the red welts on both her abdomen and back. The skin eruptions looked exactly like the photographs on the Internet for shingles.  I felt much better and then explained to Duang what she had and that she was not in any danger of dying.  She told me not to talk about the progression of the welts on her back because that would accelerate their migration - a request that I could comply with although I did not believe in its efficacy.

Duang After Being Treated the First Time of Nine Times

Duang took her modern medicine all day Tuesday - anti viral pills five times a day, anti-viral ointment three times a day, an anti-seizure/pain medicine once a day, Tylenol. and Valium for sleeping at night.  Of course as is the case here, a great deal of time was spent throughout the day consulting with family and friends.  Many people confirmed that if the welts from the "like snake" inside of Duang met up to form a complete circle around her torso she would die.  On the brighter side, Duang's condition was not a rare one.  Many of the people had either had or knew of some one who had had the same problem.

One of Duang's best friends. Madame Gei, had had the condition as well as her husband.  She knew of a special man, a shaman, who had cured her, her husband, and two of her friends.  This was great news ... to Duang.  Wednesday morning we drove out to Madame Gei's home and followed her to the shaman's home.  Madame Gei did not know exactly where he lived but when we stopped and asked people they knew exactly who we were looking for.  We parked are vehicles there, crossed the main road, and walked a short distance down a narrow street to his home.  He was not home but a call was made by his wife for him to return home.

After a while, the middle aged man returned home.  In addition to being a shaman he is also a policeman!  I knew that he had cured people of the condition before but I was not sure what his qualifications were.  Duang asked for me and I learned that his deceased father had been a shaman with healing knowledge and powers.  The policeman had watched and learned from his father.

He had Duang sit on a plastic chair out in the street.  He placed some betel nut chewing material in his mouth but without the leaf or lime.  After a few chews and making an offering prayer to the spirits. he sprayed the semi dry material forceably on the welts on Duang's body.  This was the first treatment of three for that day to be followed by two more days of three treatments each.

That evening Duang returned home in much better spirits and in much less pain as well as itching.  It was a vast improvement over the previous day and the morning.  Was it due to the antivirals that she had taken and continued to take?  Was it due to the shaman's treatment?  Perhaps a combination of the two?  I don't know and it really didn't matter.  She was feeling better and in better spirits which is all that mattered.  The shaman called that night to check on her condition.

The next day when she went to be treated, he checked her welts and told her that she had been scratching them which he had told her not to do.  After being caught and called out, Duang no longer scratched the eruptions.

Duang's abdomen after two days of treatment

After two days of treatment, Duang is feeling better and confident that tomorrow will complete her treatments.  She continues to take her modern medicine too.  I call to ensure that she maintains her prescribed schedule for taking anti virals.

Duang's back after today's treatment

Tomorrow Duang will receive her last three treatments from the shaman.  On the 28th she will return to see the doctor at the hospital.  The good news, for what ever reason, is that she is able to sleep. the burning is gone, the pain is much less and she is in good spirits.

In Isaan there are more than one way to live and more than one way to be cured.  Personally though I will stick to modern medicine if my body is not able to first heal itself.

It Takes A Village to Heal A Child - At Least In Isaan

It has been a few days since my last blog. The lack of blogs has not been due to a lack of subjects but because we have been very busy. Much of our time has been spent at the hospital in Kumphawapi. Our grandson, Peelawat, has been hospitalized for three days.

Peelawat has been been living in Tahsang Village with his mother at his Great-Grandmother's home. In Tahsang Village, he spends a great deal of his time playing with his two and one half year old cousin, Kwan, and three year old neighbor, Tay. Like all other 16 month old children in Isaan, Peelawat's play involves walking around bare foot, playing in the dirt, running after chickens and puppies. All the toddlers carry evidence of their play on their ankles, legs and arms. Nicks, scrapes, and scabs bear testament to the fun that they have been having on these hot and humid days in Isaan.

Monday morning, we received a phone call from Duang's daughter saying that Peelawat was sick. He had a fever and had experienced a couple seizures. Previously when he had fevers, Peelawat had experienced seizures. At first this was extremely concerning to us but after researching I determined that these seizures are somewhat common in young children. Later I found out that Duang as well as her two children had the same experience with fevers when they were young. This made me somewhat more relaxed but I still had concerns about epilepsy or some other serious condition. Duang's daughter had a cousin take them to a clinic in Khumphawapi to see a doctor. Peelawat had a seizure at the clinic. He received treatment and returned to Tahsang Village.

Later that evening we received another, more stressful, call from Duang's daughter saying that Peelawat was running a fever, had additional seizures, and was being hospitalized. Peelawat and his parents had been taken to the hospital in Kumphawapi by one of the uncles in Tahsang Village who had a pickup truck. Most people in Isaan have motorbikes but out in the villages few people have trucks and even fewer have cars. People with vehicles are often called upon to help out in emergencies. With the emergency notification, Duang, her son, and I headed off to Kumphawapi.

We arrived at the hospital and found Peelawat in the Emergency Room. He seemed so small and defenseless laying on the gurney swathed in a blanket with an oxygen mask on. He was very feverish and in that quasi conscious state that a high fever induces. After a while, he was transported to the Pediatric Building of the hospital. Since the NICU is located on the second floor and there is no elevator, I had to carry him up the two flights of stairs to the NICU.

Although the sign above the entrance to the ward said "NICU" (Natal Intensive Care Unit), the room was more of a children's ward than what we expect to find as a Intensive Care Unit in the USA. The room was very similar to other hospital wards here in Isaan. It was a large room divided in two sections by a five foot high block wall. Each section contained 16 beds. A couple of ceiling fans provided ventilation for each of the sections. At the end of the room there was a large area that had several shower stalls and toilet stalls. Just to the left of the entrance to the bathroom area, there were a couple of large steel cabinets with hospital linens. There was a fairly large Nurse's Office, which was air conditioned, at the middle and front of the ward. Approximately 4 nurses were in and out of the office.

Here in Isaan, the Nurses handle taking vital signs, and giving medicine. They do not provide care for the patients such as bathing, dressing, changing bedding, feeding, or assisting in the personal hygiene of the patients. The family and friends of the patient provide patient care. Since there are such large families and such a strong sense of community here, the hospital wards are always filled with people. In addition there are many people congregated outside of the wards - eating, resting, and socializing while they await their turn to give care and comfort to the sick. While this may be reassuring during times of normal sickness, I fear the consequences of this behavior if the fears of a SARS, H1N51, or some other horrible epidemic become reality. Containment will not be possible.

The ward was filled with patients from two weeks old to about 12 years old. Each patient had two to four people attending to them. Surprisingly, many of the adults caring for the little patients were men. Lao Loum men are very involved in the raising of their children. Uncles are also involved in helping to care for their nephews and nieces. Peelawat had his grandfather, grandmother, mother, father, uncle, a couple of great aunts, a great uncle, and two cousins - a couple more attendants than typical that night. The ward was filled with the sounds of babies crying out of fear and from pain.

The young patients were placed in full sized hospital beds. The beds had been modified for young patients by the addition of smooth nylon string in a lattice pattern to reduce the spaces on the pop up rails on the side of the bed. Very young patients sleep with their mother in the hospital bed. Older patients mothers or fathers sleep under the hospital bed or on the balcony outside of the ward - if they get to sleep at all.

Duang and her daughter kept busy wiping Peelawat down with tepid water to break his fever. I occupied myself trying to comfort him. Peelawat was confused about the situation. One thing that he was sure of as well as adamant about - he wanted out of the hospital. He remembered the way into the ward and he was constantly pointing toward the entrance indicating that he wanted OUT and expected me to take him out.

Sadly just about every time that Peelawat calmed down a little bit and started to get some much needed sleep, a Nurse came by to check his temperature, collect blood, or give him a shot. After awhile, the Nurses decided to connect Peelawat to an IV. Just about every other patient on the ward was hooked up to an IV. One of the younger Nurses tried to put a needle into his foot. She tried and tried to no avail. Peelawat very quickly understood what was going to happen when the piece of surgical tubing was wrapped around his arm or leg. After about 5 minutes of stabbing and jabbing Peelawat to connect an IV, I said "Enough. No More, she doesn't know what she is doing. Get someone else to try". Thankfully, whether they understood me or not, another Nurse took over. Three nurses moved Peelawat's bed over to be in better light to assist in finding a vein. In the end it took a third nurse to finally connect the IV.

A Doctor was not available to examine Peelawat or any of the other patients until the next morning. I tried to determine what medicine Peelawat was getting - fighting against the language barrier as well as the cultural barrier. Medicine in Isaan is similar to the type of medicine practiced in the USA 50 years ago and longer ago in the USA - The Doctor is always right, the Doctor has no obligation to explain treatments, the patient is just to take the medicine given to them, and the Doctor is infallible. After some time I learned that Peelawat had been given an antibiotic. This seemed reasonable to me and reassuring. I was also satisfied that blood as well as urine samples had been collected. After four hours we left the hospital and returned home.

The next morning, we were back at the hospital at 8:00 A.M. I noticed that Peelawat's ankle was swollen, very hot, as well as surrounded by a black band. It was obvious that there were several red ant, weaver ant, bite marks on that leg - not an unusual sight on village children in Isaan. I pointed this out to Duang and she told me that some people in Tahsang Village had the same thing only higher on their body and they had died. This was not comforting news. Duang informed me that some of the old people in the village know what to do. She added that they make medicine and blow it onto the affected area. I asked what kind of medicine and she disturbed me once again - "same same Momma chew" Betel nut? I asked her to make sure that the Doctor took a good look at that area. I was suspicious that Peelwat had what is often commonly referred to, in accurately, as "Blood Poisoning". The actual condition is "Bacteremia", bacterial infection of the blood. The Doctor had not arrived at the ward by Noon when I left. The Doctor had been delayed because of so many adult patients in the other building. Duang called the Village to arrange for one of the older villagers to be brought to the hospital to treat Peelawat. When Duang returned home she informed me that the Doctor had not seen Peelawat but he had authorized more antibiotics for Peelawat. She also told me that a man from the village had visited and given Peelawat the first of his three "treatments"

Duang returned to the hospital the next morning to help her daughter to care for Peelawat. Her daughter and son-in-law had spent two mostly sleepless nights at the hospital. The good news was that Peelawat was feeling better. He had been chasing the same stray cat out the ward that I had chased the night before. The hospital has several stray cats that have run of most of the facilities. The cats eat the uneaten food off of the metal trays that are placed at the end of the corridor awaiting pick up at some time. I suspect that the cat's diet is also supplemented by rodents since I have not seen any around.


At 5:30 P.M. I returned to the hospital with Duang's son and his girl friend. As we pulled into the parking lot we saw a very good sight - Peelawat and Duang were sitting outside waiting for us. Peelawat had a shunt installed in his hand but other than that he looked excellent. His fever was gone and he had his energy back. He enjoyed having his photograph taken and had to see each picture on the camera's monitor after it was taken. He eagerly displayed his "Big Smile" more like a soundless lion's roar when asked.


We went back upstairs to the ward and let Peelawat play on the outside balcony. Peelawat still was pointing to the exit and now that he was mobile, he often took off for the stairway to leave the facilities. Peelawat amused himself by playing with the various shoes placed outside the doorway to the ward. Peelawat kept himself busy by trying on the various shoes. He wore mens as well as women's shoes irregardless of their size. He was very adapt at ensuring that he selected matching shoes. Later he started to play with a bed table that was stored on the balcony. He amused himself turning the crank on the table and pulling as well as pushing the table along the corridor. After awhile he indicated to me that he wanted to get on top of the table. Being a somewhat indulgent grandfather and somewhat bored, I placed him on the table. Peelawat lay on his stomach and had such a big smile as I pushed him down the corridor that I decided to share his pleasure with Duang. I wheeled him into the ward and quickly discovered that the nurses were not amused. Duang scolded me and Peelawat and I went back outside. We limited ourselves to the simple pleasure of sitting in a chair and kicking our feet back and forth while learning the English words for parts of our face.



After awhile, Duang's son returned from Tahsang Village with one of the village elders to give Peelawat his second treatment. The man had a small plastic bag with a green leaf, slices of Betel Nut, and some wood chips. He placed the items into a small brass mortar and ground them together with a small brass pestle. He sat next to Peelawat on a concrete bench on the outside balcony. Peelawat was not afraid at all and sat patiently next to the man. The man, a spiritual leader, chewed the ground up concoction and soon had a mouth full of red liquid. He examined Peelawat's infected leg, said some chants, and sprayed the red liquid on the infected portion of his leg three times. Peelawat observed the ritual with interest. The man also placed his hand on Peelawat's head and said some chants before blow air three times on the top of the head. Peelawat then pointed to a scab on his other leg to the shaman and said "Nee" (here). Somehow Peelawat inherently understood what the shaman was doing and he was pointing out to him another one of his injuries for special treatment. We all had a good laugh. Having been informed by Duang that Peelawat had received more intravenous antibotics at 6:00 P.M. and that the Doctor had scraped the skin on his leg while putting some medicine on it, I was not opposed to the traditional treatment.

After the man completed treating Peelawat, Peelawat thanked him by giving him a wai, the Thai gesture of respect which is similar to the Western prayer gesture. We left the hospital at 9:00 P.M. much relieved that Peelwat is well on his way to recovery. Peelawat will be released today from the hospital once the doctor has checked him.

Once again the differences between health care in Isaan and health care in the USA had been made very apparent. Here in Isaan health care is much more of a community effort. Family members as well as friends or neighbors are heavily involved in caring for the sick. The play on the old African proverb ("It takes a village to raise a child") - "It takes a village to cure a child" is not too far from the truth - at least here in Isaan.