12 May 2000

This will be our last update until we return to the states in just one week!

News from Jennifier

For those of you who are interested, I thought I would give you a more detailed description of my work with Melodie. A typical day for me goes something like this: I wake up between 6:30 and 7:00 and have my devotional time. From 7:30 to 8:00 Eric and I eat breakfast with the McDaniels. Throughout breakfast I work with Melodie on appropriate "western" table etiquette (the McDaniels' cook sets a fairly bad example for Melodie in this respect as she eats in the "traditional" Karen hill-tribe way -- with her fingers!). Starting at 8:00 I help Melba enforce the behavior modification plan (BMP) that I have designed and implemented for Melodie's three 30-minute morning home school sessions with Melba. These last 30 minutes each only if Melodie exhibits no inappropriate behaviors (hitting, kissing, noncompliance with instructions, etc.). When Melodie exhibits one of the predetermined maladaptive behaviors, she receives a 30-second "basket-hold" from either Melba or me and then the session's timer starts over for another 30 minutes (negative punishments). When Melodie successfully completes a 30-minute session with good behavior, she is given a 5-minute break during which she is allowed to engage in any reasonable activity she requests (positive reinforcement). Her favorite rewards are playing with the new kittens, mopping the floor, and watching her "Christy" videos. Because each session starts over every time Melodie misbehaves, this block of time can last anywhere from 1 1/2 hours to infinity, theoretically, but the longest has lasted 5 hours.

For the remainder of the morning, I do physical therapy (PT) with Melodie while Melba reads, does the bookkeeping for the hospital, and prepares her lesson plans. The PT activities include: hand massage, cross crawling, cross creeping, skipping, left-hand extension exercises, left-finger oppositions exercises, pull-ups, walking with ankle and wrist weights, log rolling, push-ups, word identification, visual digit span, tracking, figure eights, dressing and undressing, playing catch, dish washing, bike riding, and spinning (Melodie does not get dizzy easily because her cerebellum is underdeveloped. Believe it or not, Melodie would be much better off if she could get dizzy. This exercise is designed to help her cerebellum develop more).

I eat lunch with Eric from 12:30 to 1:30, and then we start another three school Sessions. I wrap up the day with another round of physical therapy with Melodie. Melba is really getting the hang of the BMP and seems encouraged to now have an effective routine in place that enables her to keep Melodie in control and make home school possible.

In addition to the daily work with Melodie I have also done some computer work for Dr. McDaniel during the last two weeks. My Tuesday solitude days have been great. Each week I drive to the nearby town of Sangkla and spend the day by the water of the reservoir fed by the Songkalia River. I find it very easy to sense God's presence here because of the obvious evidence of his creation in the beautiful scenery.

News from Eric

Taking a medical history can be quite challenging here where five different languages are routinely spoken by the patients. Sometimes it is relatively easy -- when Petak is translating Thai or Karen into English, for example. But at times it is really difficult. The other day, I was interviewing a patient who speaks only Mon. This language is spoken by only four of the hospital staff, none of whom speak English. At the time, my translator was L'ong, the hospital's administrative assistant, who speaks fluent Thai, Karen, and English, but no Mon. We were able to determine that the patient's sister spoke both Mon and Burmese, so we recruited Meechai who speaks fluent Burmese, Thai, and Karen (but only a little English) to help us. For the next 15 minutes I would ask a question in English which L'ong would translate into Thai which Meechai would translate into Burmese which the patient's sister would translate into Mon and then the answer would come back through the opposite route. It was a bit like playing the elementary school game of "Telephone," and the responses to my questions were often as jumbled as the final statement becomes in that game. At one point I asked, "Is the abdominal pain better or worse after you eat?" The response that came back was, "I have no pain today."

I saw the 13-year-old Karen boy from Ton Yang, the nearby Karen refugee camp, for an outpatient follow-up visit yesterday. This was the really sick boy who had come in while Dr. McDaniel was away and on whom we later operated. While he was looking much brighter, he had not yet gained any weight, and he complained of feeling very fatigued. When we asked him what he had been getting to eat in the refugee camp, he replied, "only rice, a little bit of salt, and water." It was unclear whether he had been given this diet because there was nothing else to eat in the camp or because of the misguided belief held by many of the locals that when recovering from illness, only rice, salt, and water are good for you. Either way, this "rehabilitation" plan was unacceptable to me (and to the patient--he wanted some chicken!), so I admitted him to the hospital "sala" where we can be sure that he will get a high-protein diet to aid him in his recovery.

Last week I gave a short "lecture" on how to measure the Ankle-Brachial blood pressure Index (ABI). This is a simple, non-invasive test used to detect large degrees of arterial narrowing in the blood vessels supplying the legs. The "Pocket-Doppler" machine that we brought with us has given the hospital the capability to perform this test. The nurses and nurse-aides seemed to enjoy watching me demonstrate the test on Meechai, the hospital chaplain (whose lower extremity arteries seem quite normal). The test was also popular among the patients -- by the end of the day, four patients who had been lining up for the morning clinic while I was teaching specifically requested that the test be performed on them even though none of them were having any trouble with their legs -- two of them had malaria, one had a cold, and one had a hernia!

Last Friday, we were invited to the wedding of Dr. Sakda and his bride, Chin. The ceremony was held outside (brave, considering how much rain we have had recently) and was pretty western in format and dress. It is traditionally considered a mark of status here to imitate the western world (especially the USA) during your wedding, so this was pretty much expected of "Dr." Sakda. In contrast, the wedding reception was anything but western. To give you an idea of what it was like, I'll tell you the 11-course menu:

  1. Shrimp wafers
  2. Appetizer plate consisting of fried pork fat, pineapple, sausage, peanuts, and "horse piss" pickled eggs (named after the odor of the pickling broth)
  3. Whole (and I mean WHOLE) baked fish with cilantro
  4. Whole roasted duck
  5. Whole fried fish with spring onions
  6. "Bird's nest soup" made from fish bladders, chicken, and congealed regurgitated bird stomach contents (with which this particular species of bird makes its nest) with bird eggs
  7. Pig cartilage and intestine soup
  8. Cold squid and mussel salad
  9. Whole fish soup "on the flame"
  10. Pork fried rice
  11. Dessert: taro, jackfruit, kidney beans, and rice-flour jellies in coconut milk

Apparently the rice is served as the last course before dessert to indicate to the guests that the hosts are not cheap - that they filled the guests' bellies with the "expensive" food and saved the "cheap" food for after everyone was full. Jenn commented to me that it was the first time she had ever left an 11-course meal hungry! Nevertheless, we felt honored to be invited to Dr. Sakda's "big day" after only knowing him for such a short time.

For some reason, I always feel rushed to get these updates off and so I never feel like I'm giving them good closure, but such is the busy life here at the Kwai River Christian Hospital. We'll let you know when we've returned safely home and give you some reflective closing thoughts at that time.

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