Love During My Time of Cholera

The news out of Haiti in regards to the current cholera outbreak continues to be a concern.  People continue to contract the disease, suffer, and for some; die.  The outbreak appears to be spreading and given the living as well as sanitary conditions in Haiti its spread is no surprise.

As a child I remember reading stories of people suffering and dying from cholera in WWII prison camps or in Southeast Asia jungles.  From school history books, I learned of historical cholera outbreaks in America as well as in Europe due to the lack of proper sanitation facilities and procedures.

Cholera to me was an old historical disease of far away places that as a person living in Connecticut I had no reason to fear.  Cholera was a disease of the old and primitive world.  Cholera, in the modern world, was a disease found only in exotic lands such as Bangladesh - so I thought.

In September 2007, I started working on a project in northern Vietnam.  I was assigned to a project in the Halong Bay area not far from the port city of Haiphong and about 3 hours north of Hanoi.  Once again the exotic and distant lands that I learned of during my youth from books, newspapers, television, and movies had become part of my life experience.  Just as I had visited the "lost" Inca city of Machu Picchu, rode upon the waters of Lake Titicaca, climbed the ruins of Angkor Wat, and enjoyed the natural wonders of America as well as Canada, I was enjoying the opportunities of a far away land.

I arrived in Vietnam in early September, and after settling into a rented villa I returned to Thailand in Mid-October for a weekend in order to bring Duang back to Vietnam.

Later in the year I attended a special dinner hosted by our Chinese client in their facilities at the job site.  The "Team Building" dinner was held on a Friday night and besides copious amounts of vodka and beer, there were many seafood dishes.  Some of the seafood was raw and we ate it without hesitation or concern.  After an uneventful weekend, I returned to work on Monday morning.  During the morning, I started to not feel very well.  After lunch, I was very sick.  Getting sick at work is never a pleasant experience.  Getting sick at this particular job site was extremely unpleasant.  Toilet paper was not stocked in the stalls; what you had to use was what you brought with you.  Worst of all, there were only squat toilets.  Western flush toilets did not exist at the job site.

Inside of each stall was a 8 inch high tiled raised platform.  A toilet bowl was built into the raised platform with the top of the bowl flush with the surface of the platform.  The contents in the recessed bowl were removed by opening a valve to let a stream of water flush the contents down the drain pipe at the bottom of the bowl.  I have used squat toilets but I am still fearful of two things when using them; dropping my wallet into the toilet, and soiling my clothes.  I address my fear of dropping my wallet into the toilet by removing my wallet from my back pocket and relocating it deep into a side pocket of my trousers.  As for my fear of soiling my clothing - I am working on convincing myself that the geometry as well as anatomy prevent such a disaster from happening.  However I am not a true believer - yet.  As an added precaution; after I get in the proper location, assume the squat position, I use my right hand to grab and pull my trousers as well as underwear forward out of any perceived danger zone.  To date I have always been successful so I doubt that I will change my practice.

Being sick at both ends is always unpleasant but in Vietnam using a squat toilet it was even greater challenge and even more unpleasant.  I did not manage to make it to quitting time.  I had the company driver take me back home.

Duang immediately wanted me to go to a doctor or to a hospital.  I had severe vomiting and diarrhea.  I was unable to anything down or in me.  I had had amoebic dysentery before when I lived in Algeria so I realized that I did not have dysentery.  I did not have a temperature so I suspected that I did not have food poisoning.  I suspected that I had a 24 hour virus that would pass without intervention.

I tried without any success to keep myself hydrated the remainder of the day.  I made a home made batch of rehydration fluid - boiled water, sugar, and salt, but like everything else my body quickly eliminated it.  At bedtime, Duang attempted once again to convince me to immediately see a doctor or to go to the hospital.  I was still convinced that I had a 24 hour virus albeit unlike any virus that I had experienced before.  My diarrhea had evolved to cloudy watery discharge with a slight fish odor.  Most alarming was that each discharge was about one quart in volume.  I finally relented and promised Duang at 10:00 P.M. that if I were not better the next morning I would go and see a doctor.  As I promised her I could see that she was very concerned and had two streams of tears silently running down her cheeks.

At 1:00 A.M. , I experienced my worst attack.  I sat on the western style toilet with a plastic bucket in my lap.  It was truly disgusting.  After awhile Duang entered the bathroom.  I told her to stay out.  I did not to be in the bathroom with myself let alone subject her to the situation.  She refused.  In the manner in which she refused to leave, I knew that further argument with her would be futile.  She stood by me wiping my forehead and neck with a cool damp washcloth while I suffered the ravishes of my ailment.

We spent a long and fitful night together, mostly spent in the bathroom.  At morning's first light, I called the Site Manager and informed him that I would not be into work that day.  Around 8:00 A.M. I called a Vietnamese friend and asked him to take me to a doctor or to the hospital.  I then checked the Internet for email messages.  As luck or good fortune would have it, there was a "Warden's Message" from the US Embassy in Hanoi.  The "Warden's Message" informed Americans living in Vietnam that the Vietnamese government had announced a breakout of severe diarrhea in northern provinces and that some of the cases had been diagnosed as Cholera.  That definitely piqued my curiosity.  I googled "Cholera" and researched the disease.

Cholera is a bacterial infection transmitted by fecal matter in water.  The most common means of becoming infected other than drinking contaminated water is to consume raw or improperly cooked shellfish. Yes, I had done that.  The incubation period for Cholera is 1 to 3 days after exposure.  Yes, I had eaten raw shellfish 2.5 days before the start of my illness.  Not everyone gets Cholera from an exposure.  The articles stated that several people could eat the same food and not all of them would be stricken with the disease.  Susceptibility to the disease was ties to acidity levels in the stomach, blood type, immune system vitality, and to a certain extent luck. Some people who live an areas where the bacterium Vibrio cholerae is widespread develop a certain resistance to the disease.  This appeared to also be my circumstance.  After exposure, some people will only develop a case of diarrhea while others come down with a very serious case of the disease.  A symptom of cholera is vomiting.  Yes I had that for sure and it was a reason why I knew that I did not have amoebic dysentery. The diarrhea associated with cholera is sometimes referred to as "rice water".  Yes, once again that applied to my condition.

One half an hour later, my friend returned to our home with a heavy set middle aged woman on the back of his motorbike.  He had gone to the hospital and brought back a doctor.  She had a small leather "Doctor's Bag" with her.  She was wearing a simple white head covering - the type that you used to see being worn by Russian or North Vietnamese Doctors or butchers in newsreels, documentaries, and films during the 1950s and 1960s.

The doctor examined me in our bedroom with my friend translating and Duang witnessing.  After checking my vital signs, she rubbed my temples with a medicinal oil and then rubbed some of the same oil on my abdomen.  Since I knew that she was either a Buddhist or an atheist, I did not panic in mistaking her oil treatment to be part of the Catholic Church sacrament of Extreme Unction also known as "Last Rights".  I was feeling bad; very bad but I didn't feel last rights were warranted at that time.  She then cut some white patches of paper and placed them on my temples.  I had seen that before - it is the method of giving people medicine for headaches.  The doctor gave me an injection to help stop my vomiting.  I told her that I thought that I had Cholera and as luck would have it, I had another episode while she was examining me.  She asked that I not flush the toilet until after she inspected the contents.  She confirmed that I did have Cholera.  She told me to return to bed and she would return at 1:00 P.M. and check on me.

As the hours went on, I could not keep anything in me.  Although I was no longer vomiting, my diarrhea was unabated.  I also realized that I was becoming dehydrated.  When I pinched the skin at the top of my hand it very slowly returned to shape - a sign of dehydration.  I was also becoming quite light headed - another sign of dehydration.  More importantly, I realized that I was developing a rapid pulse.  Light head and rapid pulse are also symptoms of electrolyte imbalance due to the flushing of essential mineral from the body by the profuse diarrhea.

As promised the doctor returned at 1:00 P.M. .  On this visit she brought some IV bags to infuse me.  After taking my vital signs she announced that I would not be going to the hospital.  She said that I previously had a lower than normal body temperature.  If my temperature had not returned to normal by the afternoon, she was going to admit me to the hospital.  Lower than normal body temperature can be a symptom of Sepsis (massive infection).  With that concern removed, she focused on treating the Cholera.

There is no cure for Cholera.  There is a treatment for Cholera which is to keep the patient rehydrated while the infection runs its course in 24 to 48 hours.  Since I was initially unable to keep myself hydrated orally and by the afternoon I could not physically drink enough to keep up with the fluid loss from diarrhea let alone make up for the deficit that I was experiencing, I needed to be infused with fluids and electrolytes.  The coat rack from our bedroom was brought to the side of the bed and used to hold the IV bag.  The doctor hooked me up to the IV equipment and watched over me.  When the second bag of IV fluid was completed, she left - around 6:00 P.M.  Talk about personalized medical care!  The entire afternoon, Duang remained at my bedside.  She wiped my brow and held my hand - the hand not associated with the IV.  A patient could not have hoped for a better nurse.

I spent the next day regaining my strength and was good as new the following day.

The medical statistics are that fewer than 1% of the people who get prompt, and adequate fluid replacement die.  However more than 50% of the untreated people with severe Cholera die.  Antibiotics are sometimes used to expedite the treatment but antibiotics are not required to prevent death.  Fluid replacement is essential to prevent death.  In severe cases of Cholera the patient needs to be infused with fluids to maintain blood pressure and electrolytes while the infection runs its course.

From my personal experience with Cholera, I have a greater appreciation of how people who are in prison camps or do not have access to medical care can die from this disease.  I believe that if I had not gotten treatment when I did, I would have died within 24 hours.  The insidious nature of Cholera is in how rapidly it can become fatal.  The symptoms are no more severe than a normal virus infection or case of food poisoning but it is rapidity that the infection dehydrates the body that is the major risk. To ignore it or to deny treatment for a short time is really a matter of life or death.

In the case of Haiti there also a problem of containing the outbreak.  Cholera is not passed directly from person to person.  It spreads through contamination of water and food consumed by others or I would imagine direct ingestion of infected fecal matter. In my case in Vietnam, I had access to adequate sanitary facilities.  We had plenty of clean water and soap for washing our hands and disposing of waste.  Duang and others in my presence were only at risk of infection by me if my fecal matter some how entered their digestive system - extremely improbable.  However living in a tent city or refugee camp in Haiti neither provides an adequate means for disposing of waste matter, preparing foods in a sanitary manner, or ensuring clean water for drinking.  There is no wonder that the outbreak continues and that it is spreading.

My experience demonstrated to me that you do not have to have multi-million dollar facilities to treat most diseases.  I was treated in my own home.  The victims in Haiti have neither which stacks the odds further against them.

My experience with Cholera demonstrated to me that promptly seeking medical attention can be a life or death decision.  I had waited perhaps too long but adequate medical care was readily available.  The people in Haiti do not have adequate medical personnel or sufficient supplies readily available.  Any delay on their part can have dire consequences.

It was this experience that I realized or perhaps it was that I accepted that Duang was truly committed to our relationship - for better or worse.

I had experienced her love during my time of Cholera.

Comprehensive Immigration Reform - Part 6 Medical Examination



Bumrungrad Hospital Heart Bypass Package Offer

 Last night we returned to our home in Northeast Thailand from one of our many trips to Bangkok as part of the process for applying for an Immigration Visa to the USA for my wife.

The application process commenced in July of this year and it appears that it will be concluded by the end of this year.  It will be concluded in the sense that my wife will either be granted an immigrant visa or will be denied an immigrant visa.  However the final determination for my wife to enter America will actually be made by the Immigration Authorities at her point of entry to the USA within 6 months of receiving her visa.

This trip to Bangkok which I wrote about previously was to receive a required medical examination prior to my wife's personal interview at the United States Embassy later this month.  I had chosen to have the medical examination performed at Bumrungrad International Hospital.

We had made arrangements over the telephone with hospital for an 8:30 AM appointment with one of the US approved doctors.  Since it was Duang's first visit to the hospital we were instructed to arrive at 8:00 AM to register with the facility prior to the examination.

We arrived at the hospital complex at 8:00 AM and we were immediatelyy impressed.  Bumrungard International Hospital is a huge facility celebrating its 30th anniversary.  The facility is a collection of tall modern skyscrapers.  Bumrungard was listed by Newsweek magazine as one of the top ten Medical-Tourism facilities in the world.  The international aspects of the facility were immediately apparent as we exited the taxi inside the guarded gates of the facility.  Looking around at the other patients and visitors to the hospital seemed to be like a visit to the United Nations.  There were many people from the Middle East and Africa using the hospital.

As instructed, we entered the Clinic and went to the 10th floor.  The "registration" area was located on the 10th floor and resembled more of a reception area for a five star hotel or a private bank lobby.  The room was very well decorated and relaxing.  The office furniture was expensive looking.  The women who handled the registration process, were all attractive, beautiful, and dressed extremely well in appealing business type uniforms.

We sat in very comfortable heavy upholstered chairs at one of the desks.  The receptionist took down Duang's information and entered it into a computer.  As part of the registration process Duang's digital photograph was taken and printed out as part of a traveler sheet which accompanied her with vital information through her examination.  The registration process was quick and extremely efficient.  We were sent to the 15th floor and arrived there at 8:25 AM.

At the 15th floor there were 4 waiting areas, A,B,C, and D.  We were instructed to go to "D"  Each of the waiting areas had a central station manned by several women.  Examination rooms and consultation offices were located behind the stations.  In front of the central stations were large upholstered benches and chairs similar to a typical airline business class lounge.  A large flat screen television provided entertainment as well as a rack of newspapers and magazines representing the major languages of the world.  The lighting in the waiting area was carpeted and very comfortable.  Once again there was a very relaxing ambiance. We turned in Duang's traveler sheet and we sat down to wait for further instructions.  As instructed by the US Embassy website "Packet #4", I had printed out the 6 pages of forms to be filled out.  I had filled out the general information on the forms but found out that it was not necessary since the hospital already had the forms and were filling out all information themselves.

At 8:28 AM Duang's name was called and the process commenced.  During the entire examination process we were accompanied by a hospital representative.  We did not get anxious or confused about where to go next during any of the steps of the process.

The medical examination was a fairly typical examination, blood drawn, weight, height, blood pressure, checking eyes, nose, ears, throat, listening to the heart, checking the abdomen for masses, personal interview and chest x-ray.

As part of the medical examination and evaluation process, there is a determination of vaccination requirements by the doctor.  Most of the vaccinations listed in Packet #4 are more applicable to children than to adults.  The doctor determined that Duang needed to demonstrate that she had been vaccinated for Tetanus, Diphtheria, Measles, Mumps, and Rubella.  Since she has no record of vaccination and I suspect that she was never vaccinated for these diseases, the doctor had her receive Td (Tetanus and Diphtheria) and MMR (Measles, Mumps, Rubella) vaccines.  She was injected in each of her arms; she quipped "Medicine for Thailand, Medicine for America" as she pointed to each arm.

Tuesday's vaccinations are only a start.  The Td vaccine requires three doses.  The next one to be 4 to 8 weeks from now followed by the third dose 6 to 12 months after dose #2.  The MMR vaccine requires a second dose 4 to 8 weeks from now.

The examination process lasted two hours.  We were told that the paperwork would be available in one hours.  The waiting area was so comfortable and interesting  that we decided to just wait for the documents rather than leaving and returning later.  Our wait actually ended up being 1-1/2 hours due to the delay in getting the chest x-rays delivered from the lab to the doctor.

We were given a two packets of x-ray films and documents to bring to Duang's interview.  The packets were thoroughly sealed with tape along with the hospital's stamp covering both the tape and an unsealed portion of the envelopes; high security measures to prevent tampering prior to delivery to the US Embassy.

We paid for the examination, 1,930 Baht ($64.33 USD) and first doses of the vaccinations, 1,408 Baht ($46.93 USD) at a station located on the same floor as the examination facilities.  Although we did not require any medication, there was a pharmacy directly across from the cashier.

$111.26 for two vaccinations and a medical exam including chest x-ray - another reason why I enjoy living here in Thailand.  Medical care is still affordable here for expats.

During the wait, I found some hospital literature for various services.

Total knee replacement at Bumrungrad International Hospital has a median cost of $15,014 USD.

Total Hip Replacement is a median cost of  $17,483 USD.

Heart Bypass surgery is a median cost of $29,198 USD however there is a special package available for $16,633 if you pay the hospital directly!  The package deal includes doctor's fees, up to 7 days hospitalization, and in hospital medicines.  Six years ago I had surgery to repair an umbilical hernia - In the hospital at 8:00 AM and out of the hospital at 2:00 PM the same day - $15,000 USD.  There is no wonder that some people decide to come to Thailand for medical treatment.

Completing our business at Bumrungrad International Hospital was not the end of our medical dealings during this trip to Bangkok.  For about a week Duang has been complaining about one of her eyes.  We decided that upon our return to Udonthani we would go to a doctor and have it looked at.  As it turned out, throughout our stay on our way to and from our hotel, we walked by a very nice clinic inside of the CRC Tower/Conrad Hilton Hotel associated with BNH Hospital.  On our last night in Bangkok, it occurred to me to get treatment there rather than waiting to get back home.  This is Thailand - no need for an appointment; just walk in.  We saw a doctor who examined her eyes and diagnosed that she had an inflammation of the conjunctiva but not infective conjunctivitis (pink eye).  The cost of the visit as well as for the two medicines was $40 USD.

So another important milestone in our quest for an Immigration Visa has been completed.  It appears that the process will take 6 months.  In a later blog I will share how much this process actually cost.  Once again I need to remind the reader that we are following the current process for legal immigration to the USA.  Because we are legally married, Duang is allowed to go to the head of the line so to speak - "At this point, you are 6 months from maybe getting a visa".  Because I have stayed in Thailand for over a year, our application is processed here in Thailand rather being processed at one of the regional centers back in the USA.  I believe that being processed in Thailand has got to be more expeditious than going through the regional centers based solely on the workloads for regional centers as opposed to a Embassy.

It has been 5 months and counting for a specialized case; the legal spouse of a natural citizen.

Thanksgiving

Today is Thanksgiving here in Thailand; a day like every other day here.

Thailand does not celebrate or recognize the holiday.

However we do not need government sanctioning of the day to contemplate, give thanks, and to rejoice for all that is good in our life.

Yes today is a day like any other day here in Isaan - for me.  Everyday I contemplate, give thanks, and rejoice for all that is good in my life.  But it is on American Thanksgiving that I celebrate, share, and publicize it with people other than my wife.

Thanksgiving has always been one of my favorite holidays even more so than Christmas and definitely more so than New Years - specifically New Year's Eve.

Christmas carries too much emotional baggage to truly be appreciated.  After perhaps spending more money than you should have on gifts for your family, if you are fortunate you only get to witness their suppressed disappointment at the results of your efforts.  If you are less fortunate, you are told what they really wanted or asked when along with where they can exchange the gift.  You are also often put into the same situation of having to express gratitude and appreciation for receiving things that you neither wanted or needed all the while feeling guilty in recognition of the donor's efforts and generosity.

However, Thanksgiving is a time for families to gather together to feast and celebrate the blessings of the past year.  I believe that I am an optimist so a day of rejoicing and celebrating the good in life is not difficult.  Some years are not as bountiful as others.  Some years are more challenging than others.  However Thanksgiving day is a day to be thankful for what we have and not what we wished that we had or to focus on what we do not have.  If for no other reason, being alive is reason to give thanks on Thanksgiving.  With life there is hope; hope for a better tomorrow or some day after.

This Thanksgiving I am am thankful for so many things that I have.  As much as I am thankful for what I have, I am thankful for the many blessings that I had and some that I no longer can enjoy.

As much as what we have today brings us joy and contentment, it was yesterday and our past that have brought us to today.  It our past that prepared us for today and for the days to come.

Today, as for all days, I am thankful for the love, experiences, and guidance that I have received from family and friends who are no longer in this world.  They have passed on and I can no longer enjoy their presence. They affected my life in ways that are impossible to quantify or for me to express into words.  Shared experiences with them taught me and assisted me in developing my personal values.  The memories of shared holidays, vacations, celebrations, and ordinary days with them remain both a comfort as well as inspiration to me.  The gift of family, companionship and friendship is reason enough to give thanks today as well as every day.

I am thankful for having been raised in a country and time where excellent quality free public education was available to everyone.  Going to school in Groton, Connecticut in the 1950s and into the late 1960s was a blessing.  I often think back to those school years and believe that there was a unique group of teachers back then.  As students we were challenged by our teachers to do more than our best.  A quality free education is a blessing to be thankful for.  Even today in many parts of the world, children do not have access to free quality education.

I am thankful for having been raised in a country where I was free to fail and much more importantly free to succeed to the extent that I, myself, determined.  My position and goals in life were not restricted by anyone or any institution.  My parent's education, occupation, economic, or social status did not limit my prospects.  Today this is not true even in some Western countries.

I am most thankful for the way that my parents raised me.  Too often today, people blame their problems on their parents.  They blame their current behavior on their parents.  Blaming their parents, to them. absolves them of their individual responsibility and accountability for their own actions.  I know that my parents did their very best in raising their family based upon what they knew and could at the time.  Should we expect any less or demand anything more? I suspect that most parents do the same.

I was taught manners. Manners and etiquette allow individuals to function, interact and thrive in a society with minimal conflict.  Manners and etiquette help to define our value and standing as an individual and to society.  The manners and etiquette that I learned as a child have allowed me to integrate into different cultures easily where I have worked and lived.  While these may not be a blessing, they are things that I am thankful for.

I was taught that I was not special.  I am not certain how well I learned that lesson.  I suspect that most people have not completely learned that lesson well.  However I learned to not expect or demand special privileges or preferential treatment.  I expect to treated the same as any other person.  An off shoot of this lesson that I was taught throughout my youth was the realization that as an individual I had certain responsibilities to the group.  I have the responsibility to not demand that the group conform solely to appease my wishes, practices, or beliefs.  I do not necessarily have to conform but that choice is mine to make and I should be prepared for and accept the consequences.

I was taught that I could have anything that I wanted; as long as I first had the money to pay for it. I was taught and more importantly demonstrated each day.  I was taught that anything worth having was worth working for.  I was also taught that I wanted something bad enough I would work for it.  If I was not willing to work for something, I did not need it.

Today I am also thankful for my families and friends that are part of my daily life.

Thank You - all of you.

Comprehensive Immigration Reform - Part 5; Our Reason for Giving Thanks



Duang Worshiping At Her Upstairs Alcove Shrine - I know some of what she has been praying for.

 As I prepare for Thanksgiving tomorrow, here in Thailand, we have another reason to be thankful.  Yesterday we received an email notification of Duang's scheduled appointment at the US Embassy in Bangkok for her application for a Immigrant Visa to the USA.  Teaching Duang more about the meaning of Thanksgiving tomorrow will be that much easier with this shared blessing.

I am still bewildered by the status or definition of "Comprehensive Immigration Reform" in the United States.  With the conclusion of the mid-term elections in America, this news story appears to have disappeared from the media.  I suspect that the problems and issues remain as they were before.  The situation now that the elections are over with is that there is no impetus or perceived need for politicians to identify with the issue, be specific in their definition of the terms, or to imply that they have proposals let alone solutions for immigration related issues.

Back on September 29th, we had mailed a 3/4 inch thick packet of documents to the US Embassy in Bangkok as part of the current process for immigrating to the United States.  Submittal of the documents completed our portion of Packet #3 of the established procedure.  After the US Embassy had reviewed, investigated , and approved our submittal, we would be notified to proceed with Packet #4 along with notification for an interview appointment in Bangkok.  My research had indicated that it takes about 10 weeks after submitting Packet #3 to the Embassy to obtain an interview appointment provided there were no complications or rejection.  I figured that we were going to be notified soon, but I was still very pleased that my faith and belief were justified with the notification 8 weeks after transmitting the packet.

It has been a while since we sent the documents.  During this entire process, I have yet to obtain or have the name of any person working on this process given to me.  I suppose that the need for anonymity is for security reasons however it does make the process very impersonal.  There is no person that you can call with your questions or to determine the status of your case.  It sets up, in my opinion a rather adversarial atmosphere.  I do not prefer that type of atmosphere and after experiencing many interactions with government authorities here in Thailand, I am not accustomed to that sort of an attitude.  Here in Thailand, government employees that I have encountered, all wore a name tag.  If the process of applying for Immigrant Visa is to be impersonal, I can deal with it.  If the process is not as clear, I will have to deal with that also.

Duang's scheduled appointment is roughly a month from now.  At the time of her appointment, Duang will need to submit a sealed envelope containing 6 pages of documents related to her health examination as well as a chest x-ray.  As part of the Immigration Visa process, each applicant has to undergo a medical examination.  The medical examination can only be performed at specific locations and performed by specific doctors.  For applicants in Thailand, people can only be examined in either Bangkok or Chiang Mai.  In Chang Mai, there is a choice of two hospitals and three doctors.  In Bangkok, there is a selection of a hospital and a nursing home.  There are six approved examiners in Bangkok.

Chiang Mai is an 8 hour drive from our home in Udonthani.  Bangkok is a one-hour flight, 8-1/2 hour bus trip, or 6 hour drive from our home.  I considered going to Chiang Mai for the examination and combine the trip with a mini-vacation to photograph the local Hill Tribes.  I decided against it.  Given my previous experiences dealing with the bureaucracy, I believe that it would be best to go to a location in Bangkok - the US Embassy's neighborhood.  I do not want to give cause for any questioning, concerns, or confusion to delay the processing.  One of the selections in Bangkok is Bumrungrad Hospital; an international hospital which is recognized as the best hospital in Thailand.  Bumrungrad Hospital is the destination for many people who come to Thailand for Medical Tourism.  In keeping with my desire to keep our application simple and familiar to the US Embassy staff in Bangkok. I selected Bumrungrad since it is extremely close to the US Embassy.

The fee for the examination at Bumrungrad is 2,450 Baht ($81.66 USD) as opposed to 2,910 Baht ($97 USD) at the nursing home location in Bangkok and 2,000 Baht ($66.67 USD) at the Chaing Mai locations.

In addition to the medical examination, the applicant for an Immigrant Visa must provide confirmation from the medical examiner that the applicant have met US vaccination requirements.  In reviewing the listed required vaccinations, I realized that new immigrants are better protected than most Americans.  Some of the required vaccinations that surprised me were:  Hepatitis A, Hepatitis B, Human Papillomavirus (HPV), Influenza, Influenza Type b (Hib), Rotovirus, and Zoster (Chicken Pox).  Duang may not have to have all these vaccinations; it is up to the determination of the medical examiner.  I suspect that she will not need a Rotovirus vaccination which is given to infants to protect them from some of the causes of diarrhea.  I am also of the opinion that she does not need a HPV vaccine.  At the hospital here they approached Duang about getting the HPV vaccine but after researching it on the Internet I decided it was not justified.  The HPV vaccine it more suitable for young girls.  The vaccine provides protection from possible cancers possibly caused by the HPV.  However for older women or young women who have already been exposed to HPV, the vaccine has no benefit. The cost of any required vaccinations is in addition to the 2,450 Baht examination fee.

Duang At The Long Boat Races

Having decided to have Duang's medical examination done in Bangkok, I decided rather than try to accomplish the examination and interview in a single trip to Bangkok, we would make a separate trip to Bangkok just for the medical examination.  Although it is theoretically possible to accomplish both the exam and interview in two business days, I have learned over the years that it is best to plan on difficulties and then be surprised when things turn out smoothly.  I would hate to experience complications for an important as well as emotional process by not having all the documents that Duang needs for her interview due to some unanticipated complication with the medical exam.  "Complication"?  I suspect that she will need a vaccine or two.  It is possible that the vaccine might not be available at the time of her exam.  This would prevent her doctor from giving her an "All Clear" determination prior to her interview if it were the next day or two after her hospital visit.  My preference is for her to arrive at her interview with an "All Clear" determination by the Doctor.

We called Bumrungard Hospital yesterday and made an appointment without any difficulty for next week.  I asked about how long they anticipated the medical examination would take because I wanted to determine if an additional overnight stay would be required.  In the course of the conversation, the hospital representative stated that the examination would take a couple of hours in the morning and the doctor would complete the forms when the test results were available in the afternoon.  I asked if the documents could be mailed to us at our home in Udonthani.  I was not prepared for her response.  She informed me that due to "Personal Privacy" concerns in Thailand, the medical records have to be picked up in person by Duang.  Interesting and I guess it does provide a certain higher level of privacy than I am accustomed to.  Taking this into my calculations, we will spend an additional night in Bangkok to ensure that she will be able to pick up her records even if there is any "hiccup" on the day of her examination.  Since so many people spend a great deal of money to get to and stay in Bangkok for a vacation, we can't complain.  I know that we will find something to keep us amused and entertained if we do mange to have a day to burn in the city.

Duang's scheduled interview next month commences at 7:00 A.M. so we will fly down the day before.  If the decision is made to grant her an Immigrant Visa, the "visa will normally be available for pick up at the Consular Section waiting room in two business days"  Based upon this information we will fly down but will return by bus someday.  Since our return will be during the day, I don't mind traveling by bus.

Although politicians and public figures in America have not clarified or defined what they mean when they state that there is a need for comprehensive immigration reform or that they support comprehensive immigration reform, Duang and I have our path forward.  The current process is complicated, challenging, and requires patience as well as money to follow but it appears that the end for us is in sight.

One of the things that we will be thankful for tomorrow will be the approval of Duang's application up to this point as well as the opportunity for her to immigrate to America legally.

90 Day Reporting - Staying Legal



Form TM. 47

 Today, Monday 22 November, was an important day for me and my ability to remain in Thailand legally.  Today was exactly 90 days from the date of my last report to the Thailand Immigration Police.

I am often asked if I live in Thailand to which I often will smile add respond "I do not live in Thailand.  I stay in Thailand. I can stay in Thailand for a year and must reapply to stay for another year every year."

I and many other foreigners in Thailand are granted Non-Immigrant Visas based upon one of two reasons.  One reason for being granted a Non-Immigration "O" Visa is for "Retirement".  To qualify for the Non-Immigrant Visa based upon retirement, a person needs to be 50 years old, have 800,000 Baht ($26,666 USD) in a Thai bank account for three months prior applying for the visa, or have a certified income of 65,000 Baht ($2,167 USD) a month. A police report from your local police department where you live outside of Thailand is required along with a Doctor's statement.  Application is then made to a Thai Embassy or Thai Consulate.  I went back to California in May 2008 to collect the required documents and submit them to the Thai Consulate in Los Angeles, California. Two days later I walked out of the Thai Consulate with the requested visa pasted into my passport.

Each year before my current visa expires, I fill out the required form, obtain the necessary documents, get the required photocopies, and get the required photographs to visit the Thailand Immigration Police.  At the same time that I apply for an extension of my Non-Immigrant Visa, I also apply for a "Re-Entry Permit" which allows me to return to Thailand without having to get a new "Non-Immigrant Visa" after each trip outside of Thailand.  The process takes about one hour at the local Immigration Police Office in Udonthani.

Another way to stay in Thailand for up to a year is to get a Non-Immigration Visa on the basis of "Marriage".  The main differences or rather benefits between staying in Thailand due to "Marriage" rather than due to "Retirement"is that the financial requirement is 400,000 Baht in a Thai bank account or 32,500 Baht a month and you do not have to be 50 years old or older.  Those are the benefits.  But the benefits are not worth the effort if you are in a financial situation which qualifies you for the retirement justification.  Yearly extensions of your Non-Immigrant Visa are processed completely at the local level - reviewed, determined, approved, and stamped on the same day at your local Immigration Police Office.  "Marriage" Non-Immigrant Visa extensions are initially reviewed, determined, and approved at the local level.  However once the local Immigration Police have determined that you qualify for the visa, they have to send their findings to Bangkok for concurrence and final approval.  This requires extra work, time, and perhaps more importantly creates the opportunity for the local Immigration Police to lose face if Bangkok were to disagree with their initial finding.  For me the risks and effort required for a Marriage based visa greatly out weigh the benefits.  I am sticking what has worked in the past - "Retirement".

In applying for an extension of a Non-Immigrant Visa due to Marriage, you need to provide just as much evidence as you did for the initial application or the previous year's request for an extension.  The evidence includes photographs of the ceremony as well as photographs of you and your spouse together in various rooms of your home.  Sometimes witness are required to sign statements or appear in person to attest to your marriage.  This is a more complicated process and definitely more risky than maintaining a "Retirement" basis - which I do.

No matter if you qualify due to "Retirement" or "Marriage" you must report to the Immigration Police for each 90 day period that you remain in Thailand.  Reporting to the Immigration Police can be done through the mail or in person.  Since processing requires that you submit your passport to the Immigration Police, I chose to not handle the reporting by mail.  I prefer to handle the reporting in person.  I also bring my wife, Duang, with me to reinforce that we, together, are committed to fully complying with the rules and regulations for my stay.

To report to the Immigration Police, you are required to fill out Form TM. 47 "Form For Alien to Notify of Staying Longer than 90 Days".  It is a straight forward and simple document to complete.  The completed form and your passport are submitted to the Immigration Police who review it, and complete the section that is stapled into your passport which notifies you of your next reporting date.  Today we were in and out of the Immigration Police Office in 5 minutes.

My next reporting date is 22 Feb 2011 if I do not leave and reenter Thailand before then.  If I do, my next reporting date will be 90 days from the date that I reenter the Kingdom of Thailand.

Having fulfilled my obligation to report, we drove into downtown Udonthani to Duang's Ear. Nose and Throat Doctor.  Duang had two ear drums repaired over year ago.  She recently started experiencing some swishing sounds in one ear. We suspected that she may have an ear infection.  We went to the doctor to have it checked out.  As I have come to realize now - there is no need to schedule an appointment at the Doctor's office let alone a specialist's clinic.  His office opened at 8:30 A.M. so we  arrived at that time and ended up being his first patient.  DuangIsaan - a Doctor helping out a patient without charging.

Upon returning home, Duang's friend from our neighborhood stopped by to take us shopping.  She shops at a store that I had never shopped at.  Duang went with her last week and was impressed.  This week was my opportunity to check it for myself.  Makro is a warehouse type facility very similar to Sam's Club or Costco back in the USA.

As the women shopped, I wandered around the store and checked out the items that were available.  I was impressed.  The most impressive thing was that for about 95% of the items, there were signs in English as well as in Thai.  At the French chain, Carrefour, where we do our weekly shopping I would estimate that only 40 % of the items have English tags.

As I wandered along a long open floor freezer, I could not help smiling to myself.  I was thinking about the scene in the film, "Forrest Gump", where "Bubba" Blue starts reciting all the ways that shrimp can be prepared - a very funny scene.  Well lying in front of me in a variety of plastic bags and paper boxes were all kinds and types of frozen shrimp or prepared shrimp.  I honestly suspect that "Bubba" may have missed a few variants that were for sale at Makro in his narrative during the movie.

After finishing my inspection of the shrimp products, I checked out the freezers of frozen seafood which were quite impressive - mussels, clams, crab, crab products, squids, trout, grouper, grunt fish, dory, cod, sea bass, mackerel. talipia, cat fish, tuna, Pacific Salmon, Norwegian Salmon, Atlantic Salmon, eels, and some fish that I was not familiar with - but the scientific name was on the label.

There were also boxes as well as bags of shark fins which did not please me all that much after having watched a Nat Geo program on the subject a couple of night's ago. I am not against eating sharks but I am against wasting an entire shark just to get the fin which has no flavor and only adds texture to a soup.

From the seafood freezers I went on to the chicken freezers.  There may have been just as varieties of chicken products as there were previous shrimp products.  There were definitely more chicken pieces and parts than shrimp parts.  There bags which contained a whole boiled chicken in a special sauce.  There was a whole chicken as in whole complete chicken including head, neck, but I am not sure about feet though I suspect the feet were included.  Seeing the chicken with head attached reminded me of a dinner party in Vietnam.  The guy seated next to me, at a wedding reception, ate 14 chicken heads - including mine.  It is always so interesting to learn if not experience the different culinary choices around the world.

At Makro there was a freezer containing beef.  The selection of beef was the best that I have found here in Isaan.

The last freezer that I looked at was the most interesting that I had checked out.  The last freezer had some items that I am certain that Americans would not find in their local market.  There were bags of frozen partridges.  There bags of frozen frog legs.  For people who maybe hankering more than a frog leg, there were bags of frozen whole frogs.  There were frozen black chickens.  At the end of the chest there were small bags of ostrich meat. There was wild boar meat along with deer meat.  I found packages of rabbit meat.  For people who might not want to eat a mammal, there was reptilian meat - CROCODILE - "Product of Thailand".   OK, maybe your Kroger, Safeway, Big Y, Stop & Shop, Piggly Wiggly or some other market may have the aforementioned products BUT ... do they have 3 pound boxes of frozen "Bamboo CATERPILLARS"?  I think that they do not!

I was impressed with the the store - its selections, varieties, and prices.  We will being some of our shopping at this interesting store.  I can foresee us trying some different dishes using ostrich, rabbit, wild boar, deer, and even the crocodile.  However it will be a very hungry day here in Isaan before we, or more specifically I, will eat the bamboo caterpillars.  I will eat fermented fish sauce and red ants before I would even consider eating the bamboo caterpillars.

So all in all, today which could have been a rather mundane day managed to evolve into another exciting as well as educational experience here in Isaan.

New Photos Have Been Added to Gallery - Runny Noses and Dirty Faces

Twenty new photographs have been added to the photo gallery, "Runny Noses and Dirty Faces - Children", available for viewing at the link below:

http://www.hale-worldphotography.com/Children/Runny-Noses-and-Dirty-Faces/7422101_oLip3

The Race Is Done, The Races Are Done

Duang Wears Her Funeral Clothes to the Races

Prior to going to the final long boat races in Kumphawapi on Sunday, we attended a funeral in Tahsang Village for one of Duang's relatives.  The woman was 82 years old and had been ill for a long period of time.  She had not left her home in 10 years.  Her race is done. The big difference for this funeral was that it was a Christian funeral.  Duang had never been to a Christian funeral before and I could tell that she was a little apprehensive about attending.

Unlike the typical Lao Loum Buddhist funerals that we have attended there was a noticeable effort made by people to wear black clothing.  Buddhist funerals based upon my experience are a pretty much come as you are ceremony.  At Buddhist funeral rituals, I have not seen people dressed for mourning.  At the Sunday Christian funeral the women were dressed in black and the men if they were not in black wore dark more formal clothing.  Soccer shirts were not the fashion of the day for the funeral.  Duang had made a black lined lace long length skirt and blouse some time ago so she was dressed appropriately.

We first stopped at Duang's mother's house in the village and picked up Peelawat to attend the funeral with us.  When we arrived at the home of the deceased relative there were many similarities and many differences with a Buddhist funeral.  OK - the obvious one - there were no Monks.  This may seem a facetious remark, but after awhile of living here in Isaan you become accustomed to and expect to see Buddhist Monks at all events.  To not see Monks at an event is a revelation.

The body was inside one of the refrigerated rental coffins that are used for Buddhist funerals.  There was a large framed photograph of the deceased person supported by an easel next to the coffin - just as for a Buddhist ritual.  There were many floral bouquets surrounding the coffin.  The floral arrangements were a Western style and would be not out of place at any funeral home in the USA.  At Buddhist funerals the floral arrangements or tributes appear more Eastern style and plastic. In addition to floral arrangements there were some some black signs with silver writing - I assume to the effect of "Rest In Peace"  Unlike a Buddhist funeral, there were no offerings of robes, blankets, rice, food or whiskey placed on top of the coffin.  There were several lit candles on the floor in front of the coffin but no Joss sticks.  People knelt on sahts in front of the coffin and candles to say their prayers.

Outside of the home the scene was very much like a Buddhist funeral.  Women were busy preparing the traditional foods that are served to guests at special celebrations or ceremonies - sticky rice, cucumbers and salad greens, pork larb, raw beef with chilies, and meat soup.  The cooking was performed over a combination of charcoal and propane fires.

Tables and chairs were set up underneath the canopies for guests to eat and wait.  On each of the tables there were 1.25 liter bottles of Coke and Sprite as well as bottled water.  There was also a small metal bucket of ice cubes for the soft drinks.  This was just like a Buddhist funeral.  However, unlike a Buddhist funeral there were no bottles of beer of whiskey available for the guests.  In addition, unlike the Buddhist funerals that I have attended, there were no card games or other forms of gambling going on.  There is, as they used to say in the Old West or at least in the Old West movies, a new sheriff in town.  Gambling is illegal in Thailand except for the National Lottery.  It is just like in America with drugs and prostitution being illegal.  If you are looking for it you will find it and often quite easily.  Here in Isaan "arrangements" or "accommodations" can be made to ensure that your card games, dice games, or numbers game will not be interrupted or more importantly - you will not be interfered with.  The former arrangements are no longer valid or available.  There is a new head police official in the area and he is cracking down.  Even with the Police crackdown, I believe that there would not have been any gambling at the Christian funeral - Duang's Christian relatives are rather conservative and fundamentalists.

The funeral ritual commenced with ... well the best way that I can describe it as was a pep rally cheer.  Duang's cousin who appeared to be like a Deacon got up and said something like , according to Duang, "Christian good" to which the congregation punched their fists in the air and shouted "Amen" and "Hallelujah"  This was repeated three times.  The people then sang a song to the accompaniment of a guitar and keyboard.  I was not familiar with the song but it sounded nice and seemed appropriate for the occasion.  Duang asked me if the same thing would happen when we attend a funeral in America.  I attempted to explain to her the differences between the various Christian denominations and how their rituals are different.  I think that she understood but then again I have explained Christmas to her but when I deviated from the religious aspects of it and brought in Santa Claus - "the wheels fell off the vehicle". 

When divine intervention is sought for our family back in America she prays to Santa Claus as well as Buddha in her nightly ritual.  When conditions improve, she points out to me "Good. You see Buddha and Santa Claus take care, take care good"  I now realize that all this confusion could have been avoided if I had not put money in her sock that was hung with care in front of the hotel television set of our room in Bangkok on Christmas Eve two years ago. Since she is so comfortable in her believes, I don't make a good thing worse by trying to explain even more.

After explaining some of the differences between a Roman Catholic funeral ritual and Protestant funeral ritual, Peelawat decided he had had enough and he wanted to go back home.  I drove him back to his home so I missed the remainder of the funeral.  After awhile Duang walked back to her Mom's house and we were ready to leave.  We did not leave for the races quite yet.  We had to visit another cousin's house in the village.  We had attended their Christian wedding a while ago and now they had a one month old daughter.  The baby was having a Bai Sii ceremony (Animist Ritual) later that day to, depending upon your religious persuasion; welcome the baby into the community and family or to bind the necessary 32 spirits inside of her so that she would be healthy, and have good luck.  No matter the reason for the ritual, everyone could agree that it was cause for a party.  There would be live music, food, beer and whiskey after the ritual.  We paid our respects to the family and especially the sleeping baby before heading out to the races.  Although we were invited to the party, we were not going to attend. It had already been a busy weekend and we were getting tired.

Just as the previous day, finding parking was no problem at the races.  It was a warm afternoon and Duang was not dressed comfortablely for a full day at the races.  She was wearing her funeral outfit as well as short high heels - not very appropriate for walking on the rough bank of the levee.  I realized that we would make only a short stay at the races.  Other factors were to play in the decision to stay only a short time.

We walked up a dirt road to the top of the levee and headed to the starting line.  There was definitely more people watching the races than the previous day.  Everyone appeared to be in good spirits - literally and figuratively.  The beer and whiskey was flowing easily.

We found Duang's brother where we found him the previous day.  We bought a Lemon Ice Tea to enjoy and to cool off a little.  He was in a shaded area so I told Duang to stay with him while I took some photos.

One Way of Traveling In Isaan

I used to take photographs mainly of landscapes and animals.  However my overseas experiences have allowed me to evolve into mainly photographs of people.  Here in Southeast Asia, photographing people is not difficult.  Besides the many interesting subjects that are available, the people in general like to be photographed.  Right after leaving Duang with her brother, I saw a young father arriving with several children.  He was on a motorcycle with his two or three year old daughter in front of him.  The remaining children were in a sidecar.  Besides the beauty of the little girl, I found the children in the sidecar to be an attractive and unique subject for a photograph.  Although I was some distance away, I had a telephoto lens to capture the scene.  The young father noticed me and posed the family for me to photograph.  He was not suspicious or paranoid.  He was friendly and no doubt proud.

Oops I have been spotted - still an interesting photo

I took advantage of the situation and walked over to say hello and show the photographs to him and the children.  They appreciated the photos - well everyone except for his young daughter, she was afraid of the falang.  It is always interesting to realize how different we are and to young children frightening because of our appearance.  I don't take it personally.  I take it as an opportunity to demonstrate to a small child that falang (foreigners) despite our looks can be "Khun jai dai" (people with a good heart).  Yesterday the little girl was not buying anything that I was selling.  She remained suspicious and apprehensive much to her father and her uncle's amusement.  They asked me to photograph them so i was pleased to accommodate them.

After spending some time with the family taking their photos, showing their photos to them and trying to communicate I was a marked man.  Duang had joined me on my walk along the top of the levee.  People would try to talk in English and then would be amused when I answered back in Isaan.  I came upon a large group of young been who had been celebrating.  They wanted their photo taken so I obliged.

ATeam that Told Me that they were #1- one of several teams to do so that day

A little further along the levee another team stopped and wanted their photo taken.  I asked them if they were "Number 1" and they said that they were.  I told them in my limited Thai that I did not understand because the other team had told me that they were #1 and they had different uniforms.  They caught on to my joke and we had a big laugh.

Another Team Claiming to be #1 - I guess that they are all winners

I had Duang stay in the shade while I went off to take a few photographs prior to leaving.  I told her it would be around 15 minutes.



Most Races Are Won or Lost At the Start



A Close Race at the Midpoint

Someone is going to win, the other is going to lose - so it is in long boat racing

As I was wandering along the levee I was called over to a small bar or restaurant - a collection of plastic chairs, plastic tables, an ice chest, a charcoal fire, and a canopy.  A group of middle aged men were partying it up.  They offered me a glass of whiskey.  I declined and tried to communicate that I had to drive my truck and that the Police like falang too much for me to be stopped after drinking - an allusion to the practice where foreigners sometimes get stopped and "fined" 200 baht  ($6 USD) for Fill In The Blank  I sure didn't want to get stopped and have the Police discover I had been drinking.  The guys were very friendly and insisted that I share a drink.  Not to be unfriendly I drank the whiskey.  To be polite I stayed a little longer to talk.  They offered more drink which I declined and informed them that I had to get going because my wife would be angry.  They then wanted me to sell some whiskey.  I believe they wanted me to buy a bottle of whiskey.  I acted dumb and said that I did not understand.  Not much upsets me over here but there is one thing that really BOTHERS me and that is people assuming that because I am a foreigner I must be rich and therefore obligated to buy drinks for anyone and everyone. I don't support redistribution of wealth in America and I will not support or participate in it any where else.  Where I come from a free drink is no strings attached especially after it was politely refused to begin with let alone one free drink obligating the recipient to buy a bottle.  Just then Duang appeared.  I reminded the guys my wife would be angry and I had to go.  After introducing Duang we said good bye and left.  I told Duang it was time to go home, the people were getting too friendly for me.  She was tired and glad to hear that our days at the races had ended.

The Blue Team Approaches the Starting Area