Wednesday, September 2, 2009
Selling Human Organs - I Don't Understand
In the report it was stated that it is believed that up to 10% of the kidney transplants in the world come from the illegal sale of kidneys. These kidneys rather than coming from a genuine donor actually are procured from people for around $10,000 U. S. dollars. These purchased kidneys are then brokered for up to $100,000 U. S. dollars to patients who need a transplant to survive.
A big part of the story dealt with an alleged ring in New York, where Jewish people were buying kidneys from poor Jews out of Eastern Europe for transplantation into Jews in New York City, Boston, and Philadelphia.
I am opposed to harvesting organs from executed people or from people who have not signed a proper organ donor card. However I am confused in regards to the illegality of willingly selling one or a piece of one of your organs in the United States.
A couple of the justifications regarding the Supreme Court decision of Roe v Wade 1973 that ruled abortion was a fundamental right under the United States Constitution were the Due Process Clause of the 14th Amendment and the right to privacy.
So how is that it is legal to have an abortion which ends up ending a life but it is illegal to sell one of your organs which will end up saving a life?
Do not the same arguments that the Supreme Court used to define a woman's abortion rights not apply to anyone's rights regarding their decision to sell a part of their body?
If a woman's body is her own personal property and she is free to make her own decisions regarding the use of her body, is it not also true that our, men and women, body is our personal property and we, men and women, are free to make our own decisions regarding the use of our body even if it entails willingly selling parts of it?
The Supreme Court has found support for right to and of "privacy" in the Bill of Rights as well as the 14th Amendment to the Constitution although the right or freedom to "privacy" is not specifically stated or written in the Constitution.
I strongly believe in this "right" and "freedom" which along with the Freedom of Speech is so frequently attacked and compromised. However, I do not understand how privacy and the "freedom of contract" can be used to allow abortions and not used to allow for the selling of one's organs.
In selling of one's organs, assuming that it is fully informed and consensual, no one's rights or freedoms are abridged or violated. The most likely result of this private contract and transaction between the donor and recipient or broker is the saving of a life. We are all brought up to believe that saving a human life is a good thing. The world's major religions all support the concept of helping our fellow man as well as saving a human life.
So why is selling one of your organs illegal - other than that is what the law says now?
I don't understand.
Is it because selling organs is not politically correct - yet?
Is it because it is not part of a major political party's agenda or strategy?
Is it because the basis for defining abortion rights is fundamentally flawed and therefore can not be used to define the right to sell your body parts?
I don't understand.
Monday, August 31, 2009
Local Shopping - Shopping for Locals
Local markets are a combination of indoor permanent facilities and temporary outside facilities. The indoor facilities are large dark buildings or a series of connected buildings with corrugated sheet metal roofs. Inside there are rows and rows of fixed raised tables where the vendors set out their goods to sell. Outside facilities consist of a low raised wood rough platform typically covered with a plastic tablecloth upon which the merchandise is displayed along with a small spring scale to weigh the goods. A large umbrella protects the goods and vendor from the elements. Sometimes there is a small plastic chair or aluminum lawn chair for the vendor but quite often they sit atop the platform along with the goods. During harvest season, we often see Duang's sister and her husband there selling vegetables from their farm.
Saturday, we went shopping at the markets in Kumphawapi for food to celebrate the visit of one of Duang's friends who was visiting Tahsang Village along with her family. Eleven people had piled into a pickup truck to travel from their village to Tahsang Village. It is a typical sight on the roads of Isaan to see a pickup truck chugging along with 12 or more people representing 3 or 4 generations.
We were shopping at the local markets because the food is cheaper than at the big international stores, and most importantly of all the selection of the types of foods that the Lao Loum people eat is much greater there.
Shopping in the local markets is not just the matter of going in, grabbing what you need, paying for it and getting out. These local markets in Isaan also are centers of gossip and social interaction. People end up meeting their friends and relatives at the market so they stop and talk. The vendors also join in and ask questions about family matters. The simple task of selecting vegetables to buy also requires an involved conversation - to ensure the best quality, best price and most likely most importantly of all be perceived as a "kuhn jai dai" - a good person, someone with a good heart.
Scattered throughout the interior of the indoor portion of the Kumphawapi market there are large charcoal grills where fish and meat are cooked. Large metal ducts take the smoke and fumes up and out through the sheet metal roof. Cooked products are lined along the counter for sale. In other areas people use gas burners to cook sweets. The sweets are typically corn or rice with coconut as well as sugar added. I particularly enjoy the corn kernel- shredded coconut waffles fresh out of the waffle iron.
Inside the market the aisles are very narrow as well as crowded. You need to be careful walking because the concrete floors are not level, have abrupt changes in elevation, and are in various states of disrepair. Lighting levels are low inside the market with illumination provided by a small number of exposed fluorescent tubes and bare light bulbs. Interestingly, many of the bare light bulbs are now the eco-friendly fluorescent type. An occasional cat or street dog will also wander by to further complicate navigating through the market. On this trip, someone had placed newspaper along portions of the aisle to soak up some of the rain that had entered through the roof from an earlier rain shower.
Some of the vendors, typically those who are selling canned goods have updated their booths with small TVs or stereos. This provides some entertainment and distraction for their children or grandchildren who accompany the vendors. Between the sights, sounds, and smells, a stop at the local market is always entertaining as well as interesting.
From the Kumphawapi market we drove to the meat market - not a club or drinking establishment but a place where beef is sold. We had purchased beef there before and have never been disappointed. The freshly butchered meat hangs in the open air from metal hooks. Besides meat, the shop sells various beef products such as stomach, liver, blood, and very small plastic bags of what appears to me to be urine. I discussed this with Duang and it apparently it is urine from inside the cattle. Apparently older people like it but young don't - I guess that qualifies me as still being young.
The meat is definitely fresh - I smelled it as it hung in the open air. One thing about the lack of refrigeration - it may not prevent spoilage but it also can not hide it. If anything is less than fresh, it is obvious.Surprisingly there were hardly any flies hovering around the meat. Today unlike other visits to the meat booth, there were not any "ready reserves" tethered to the sturdy fence along side of the shop. Usually there at least two cattle tied to the fence awaiting their fate. The shop is run by a Muslim family which is fairly rare here in Isaan. There was a sign at the front of the booth written in Arabic which tipped me off that they were Muslim and that their beef was "halal" - good to Muslim standards.
We bought one kilogram of beef for 130 baht ($1.73 lb). We pointed out the portion on the hanging leg that we wanted. The female vendor took her large knife out and carved it off of the hanging chunk of meat. We had selected a more expensive cut of beef so it was 130 baht a kilogram. At the Kumphawapi market, less than a mile away, the same cut of beef is $2.00 a pound. Less expensive cuts from the leg cost 100 baht a kilogram.
Having completed our "local shopping" we completed our trip out to Tahsang Village. Everyone enjoyed the large meal and a good time was had by everyone
Thursday, August 27, 2009
New Gallery Available to View - Foz do Igaucu
Monday, August 24, 2009
New Gallery Available to View - Lapa, Brazil
Saturday, August 22, 2009
Exposure to National Healthcare - Thailand
Thailand has a Universal National Healthcare program. The program was instituted in 2001by Shinawatra Thaksin, the Thai Prime Minister who was deposed in a 2006 military coup. He remains very popular in the rural poor districts of Thailand largely due to this program as well as other programs aimed at the poor people.
Under the Thai program, poor people can sign up to get a special ID card that they can use to obtain medical services in their health district. Typical office visits cost the member 30 baht - approximately $0.90 U S Dollars. Procedures and hospitalization costs the member 30% of the invoice with the program paying the remaining 70%.
Initially Duang was informed that her brother needed an operation and that she as a family member needed to sign a release for the operation to commence. Since we were not familiar or comfortable with driving in the city to the hospital, we called Duang's son to drive us to the hospital.
We arrived at Wattana Hospital, which is a private hospital in the center of Udonthani. Duang's brother was in a small diagnostic room in the Emergency Area of the hospital. He was on an IV and was receiving oxygen. He was in considerable pain. After awhile the situation clarified somewhat. He was stricken at his home and a neighbor brought him to the nearest hospital which happened to be the private facility. He had received emergency treatment to stabilize him and to diagnose his condition including an ultrasound scan. The cost for these services were 2,060 Baht or approximately $60.58 - very cheap by USA standards but very costly to a Lao Loum performer. His girlfriend did not have enough money to pay the bill. She borrowed 2,000 baht from me to pay the bill so that we could move on to the next step. The cost of the required operation was out of the question so he needed to go to the big public hospital in Udonthani - across the pond from the private facility.
This sounds reasonable, and easily manageable. But this involved Universal Healthcare Program and like just about any government run program in any country, things are not as they seem or should be. As I wrote above, Duang's brother had an ID which allows him to obtain medical services in his health district. A person's health district corresponds to where they are listed in "Tambien Baan" - "Blue House Book". The Blue Book for Thai residents and the Yellow Book for foreigners lists the house or apartment address and lists the names of all occupants. Since Duang's brother is listed in the Blue Book for Duang's parent's house in Tahsang Village, his health district is Kumphawapi.
Kumphawapi is approximately 60 kilometers (37 miles) from the center of Udonthani with Tahsang Village about another 12 kilometers (7.5 miles) further out. This geography lesson is important especially in regards to this family emergency. Duang's brother had moved to the center of Udonthani and had not changed either his parent's house blue book or the blue book for where he was now living. Because his medical district was Kumphawapi, he was obligated to first seek treatment at the public Kumphawapi Hospital. If after evaluation at the Kumphawapi he or any other Universal Healthcare participant from that health district is deemed to need services of a larger or more sophisticated facility, they are transported typically to Udonthani or more rarely Koen Kaen (about 90 KM, 56 miles to the south).
This seemed a little incongruous to me and I asked Duang several times about this to ensure that I understood the situation as well as requirement. I fabricated a scenario where Duang would have a accident at her parent's house and had a broken leg and arm. She said that she would have to go to the Udonthani Hospital for treatment rather than the closest hospital in Kumphawapi. I assume that in a true emergency, the patient would be treated and the paperwork sorted out later.
Thankfully we pay for our own health care using private facilities. Duang has an ID card for Universal Healthcare as a backup. Private health care is still affordable for expats in Thailand. Two weeks ago Duang went to the Doctor with a stiff neck and back - the cost for the visit, two injections and two prescriptions - $3.00 U S dollars. Some expats have had their children delivered by C-Section for $850 U S Dollars.
Last night we left Duang's brother at the private hospital around 6:30 P. M. after Duang took his health care ID with her. As we left we could hear his groans and cries of agony. We headed to Tahsang Village to obtain the Blue House Book. From Duang's parent's house we were to stop at the hospital in Kumphawapi to get a medical release or transfer document that would allow her brother to be admitted into the public hospital in Udonthani. We stopped at a small shop to get some photocopies of the necessary documents made prior to stopping at the hospital.
Since it was getting on in the evening, approximately 8:30 P. M., people were busy settling in for the night. People are the relatives and friends of the patients. They range in age from 2 years old to 70 years or older. Since many of them arrived from outlying villages, they spend the night at the hospital. The hospital complex is made up of several buildings interconnected with covered walkways and ramps which provide many areas that are protected from rain. The hospital has installed concrete benches and tables in many of these semi-protected areas for visitors to bed down and eat their meals.
As we walked through the hospital complex we came upon many hand washing stations. The hospital had several signs and posters encouraging people to frequently wash their hands. The stations had running cold water, soap dispenser, paper towels, and a garbage can. People were making good use of the facilities and most of them had run out of paper towels. Many of the visitors at the hospital were wearing surgical masks. The Thai government has a very extensive education and awareness program regarding Swine Flu. It is apparent that this program is having an effect on people's efforts to prevent the spread of infection. Throughout Udonthani you see people wearing masks and washing their hands in public locations.
We took the elevator up to the sixth floor and as the door opened we encountered six patient beds set up in the elevator lobby on the sixth floor. All six beds had patients hooked up to IVs. Scattered amongst the beds were woven reed mats, sahts, on the floor. Relatives were sitting on the sahts eating and socializing.
Duang's brother was located in the second ward on the floor. To reach his ward we had to walk through an open ward of 64 male patients - all the beds were filled with patients in various conditions.
Each ward is made up of three bays with 21 beds in each bay. There is no air conditioning in the wards. Cooling is provided by ceiling mounted fans with some small ventilation fans in the windows providing some air circulation. There is a balcony running along the exterior of the ward where patients, and visitors can sit on concrete benches. There is no door on the entrance to the balcony so some air circulation is provided. There is a room one one side of the ward where the nurses are stationed. I saw 5 nurses for the 64 patients in the ward. There was one orderly also available in the ward. The ward was filled with visitors to the patients - all standing around the beds since there were no chairs for visitors.
Many of the visitors were providing care to the patients. Some people were changing the patient's clothing while others were washing the patients with wet cloths. I did not see any hospital staff performing these tasks. Some of the visitors had brought pillows from home for the patients to use.
Duang's brother was in a great deal of distress. Eventually a very young man came by dressed in typical street clothing for a young college man - it turned out that he was a doctor. I asked him what was wrong with Duang's brother and he said that he believed it to be a perforated ulcer and that they would be operating on him in a couple of hours. Apparently Duang's brother was #6 in line for the operating rooms.
Around 9:00 P.M., a nurse started her rounds but seemed more occupied in announcing that everyone had to leave now because visiting hours were over. She complained to Duang's brother that he was making too much noise - which was not surprising since he was only on a saline IV without any pain medication. His chart did not indicate that he gotten any pain killers. We left hoping and wishing all the best for him.
We returned the next day to check on her brother. It was amazing- he looked so much better. He had his operation the previous night to repair what was indeed a perforated ulcer and was on some pain medication. He had a relatively small neat bandage on his abdomen. He was able to communicate well with everyone. I was amazed.
Like people the night before, his visitors took care of him. His girlfriend washed his body with a damp cloth and after completing his "bath", his mother, brother, girl friend, and sister changed his bed clothes. I noticed that his urine collection bag strapped to the side of the bed was full and close to overflowing. I meant for Duang or some one to let a nurse know so that it could be emptied. I didn't see any hospital personnel readily available but it didn't matter. Duang and her oldest brother promptly took care of the problem. Medical care here in Isaan is definitely personal and up close.
This experience with National Healthcare although initially frustrating and the standard definitely not what I am accustomed to appears to have turned out well. I guess that it is kind of like airplane landings - a good one is any landing that you can walk away from.
Wednesday, August 19, 2009
Buying A Truck In Thailand
Two days ago we embarked upon the adventure of purchasing a new pick up truck. When I first moved to Isaan, a year ago, we started looking at buying a truck. We did not buy one because of other priorities. During the past year, I researched and learned about buying vehicles in Thailand.
Buying vehicles in Thailand is a great deal simpler than in the USA. First of all, the price is the price. There is no great deal of negotiation. Every dealer charges the same price for a vehicle in a given area. Apparently prices are relatively cheaper in Bangkok, around $800 less on a $24,000 vehicle. However Bangkok is 6 hours drive away or 8-1/2 hour bus trip away. Two round trips would be required with at least one overnight stay.
The other simplification to purchasing vehicles is the lack of choices. In Thailand, unlike the USA, there is not many accessories, trim options, customization items or upgrades available for the consumer to consider. The choice of colors is also very restricted.
We had decided upon a double cab pickup truck and after researching selected Toyota.
Having decided upon a Toyota double cab pickup truck, we were faced with 11 models. Choosing 2 wheel drive rather than 4 wheel drive vehicles, reduced the selection down to 8models. Since we only wanted manual transmission, our choices were pared down to two models with the difference between them being the size of the diesel engine (no option for gasoline engine - only diesel). One model has a 2.5L engine and the other has a 3.0L engine. The difference in price is about $1200 for the larger engine in addition to Anti-lock Braking System so we went with the larger engine model.
We were now faced with deciding on a color - 5 choices were available. We went with the Silver Metalic - just like most people in Isaan who choose the same model.
There was no choices available for the vehicle sound system - you get the standard system.
There was no choice for interior colors, textures, or fabrics - you get the standard.
There was no choice for seating options - you get the standard.
We had decided to go with the Toyota dealership closest to our house - about one mile away. Besides the advantage of it's location, one of Duang's 93 cousins is a salesman there. I had written that the price is the price but there are some things that dealerships do to sweeten the deal for customers if required to close the deal.
A month ago we visited the dealership and met with her cousin. We found out that there was a new version of the model that we wanted coming out soon and they did not have any details on it. I told them that when they had the new brochure and knew the price, to call me or rather call Duang.
The information was finally available earlier this week. Duang's cousin drove over to the house to go over everything with us. I knew that we would have to order the vehicle and would not have it for two weeks. He came by to place the order. Since he is a relative we got the "Freebies" - bed liner, floor mats, one year of class 1 insurance, window wind deflectors, and vehicle registration without having to negotiate, bluster or beg for them. Window tinting was also available but I did not want it - even for free. The roads of Isaan are not illuminated very well. Many times at night I roll down the window of Duang's son's truck to better see when turning at night.
He filled out a form, reviewed my passport to ensure that I had the proper Visa, and inspected my "Yellow Book" (House Registration for a Foreigner Occupant. I gave him 10,000 baht (about $340)as a down payment. Just before the truck is ready he will call us and give us the information so that I can arrange for my bank to electronically transfer the remaining funds to the dealership. The entire process was completed in fifteen minutes.
Our truck will cost $23,740 USD which isn't too bad compared to a comparable vehicle in the USA. However the price of sedans in Thailand is much greater than comparable models in the USA. An entry level Toyota Camry in Thailand costs $37,323 with the top model running $52,323 USD. It is no wonder that Thailand ranks number 2 behind the United states in the number of registered pickup trucks.