Biting the Dust in Cambodia (Part Three)

Author’s note: In 1997, Cambodia was embroiled in a brutal civil war, while still reeling in the aftermath of the Khmer Rouge’s reign of terror that led to the deaths of nearly a quarter of the population through execution, torture, starvation and disease.

At the same time, Cambodia was experiencing the most serious and rapidly progressing HIV/AIDS epidemic in Asia, and was on the brink of becoming one of the worst affected countries in the world. As Project Officer for STD/HIV/AIDS, I was responsible for setting up and managing UNICEF’s country program of assistance to government and international aid agencies in Cambodia, which included development of innovative multi-sector capacities for the prevention and control of HIV/AIDS in the country.

Bed Nets and Condoms

The trip with the Royal Cambodian Navy and the WHO Malaria Team was up-lifting in a number of ways.  A five hour voyage to a distant island on a comfortable Naval battleship, hosted by the fine crew and their impeccable leadership. In a flawless white uniform, the Cambodian Admiral embodied honor, responsibility, and respect.

599z3b
The Royal Cambodian Navy Admiral presenting mosquito bed nets to soldiers based on malaria-infested islands

We delivered mosquito bed nets, condoms and prevention education to soldiers based on three outer islands and treated the soldiers who were suffering from Malaria. It was refreshing to witness some humanity in the midst of so much turmoil in the society. The young military men were clearly appreciative, and the leadership worthy and honorable.

It was encouraging to see effective medical treatment solve a health problem like Malaria – at least in the short term. But bed nets, condoms and prevention education were necessary for long-term control of Malaria and HIV.

745ab
Feverish Cambodian soldiers waiting to receive malaria treatment provided by the WHO Malaria Team

Although the life saving combination drug therapy known as the “AIDS cocktail” could help manage HIV as a chronic disease, it was not a cure. And the widespread poverty and years of armed conflict which had created conditions favorable for HIV transmission in Cambodia required longer-term, multi-sector interventions to promote safer behaviors.

For example, a string of brothels on the mainland were host to many of the young men on shore leave. But would they remember and be willing to use the condoms we gave them – and sleep under the bed nets?

An Unexpected Visitor

Then there was the time I walked into my apartment and found a strange girl asleep in my bed.  It was the height of the dry season. Whatever had been dumped, spilled, drained, coughed, sneezed, shat or spat into the streets was now a swirling cloud of fine dust – just waiting to deposit germs in your lungs – resulting in a nasty bronchitis that had the whole town coughing and gagging, and I was feeling pretty sick as well.

735 (3)
Many of Phnom Penh’s streets were unpaved

I was on my lunch break – UNICEF operated on the European two-hour lunch break – and I had just finished eating at a restaurant around the corner from my apartment and was headed home for a nap. As I was leaving, I noticed an attractive Cambodian woman of about 30 eyeing me from a table next to the door. So while passing, I politely said hello, and in my limited Khmer briefly explained that I was not feeling well and needed to go home to rest before returning to work.

We parted, and I continued home. But no sooner had I put my feet up, there was a knock at the door. She had followed me home, and somehow talked my guard into letting her in the gate!

624 (2)
Local ‘car wash’ in Phnom Penh’s chronically flooded streets

So, I offered her a glass of water, and again tried my limited Khmer for some small talk before ushering her to the door and bidding her farewell – and again, thought nothing more of this. After all, I was feeling really miserable and just wanted a nap before returning to the office. So it came as a complete surprise when arriving home that night to find her fast asleep in my bed – wearing my tee shirt and gym shorts – her long black hair spilling over the pillow she clutched.

So began my friendly relationship with Vany – who had lived through the all-too-common stark suffering and death as a result of the brutal Pol Pot years. Her parents were presumed dead, and so were her husband and child. She had been working in the casino ship moored in the center of town and had been laid off – and for some reason could no longer stay with her sister, who was also working in town.

599m1
Riverside houses along the Mekong, Phnom Penh

She spoke no English, but did know some French, and I suspected she may have been the girlfriend of a resident Frenchman who had since left Cambodia, and was looking for a new boyfriend/ benefactor.

So we made a deal – she could be my housekeeper and do the marketing in return for room and board, as long as she was looking for a new job. She also became my Khmer language tutor, and stayed with me for the remainder of my time in Cambodia. My contract with UNICEF was coming to a close in a few months, but before I left Phnom Penh, she found a job and moved back in with her sister.

The Mekong Region STD/HIV/AIDS Project in Cambodia

The Project was up and running, and since that time, Cambodia has made substantial progress in preventing and mitigating the impact of HIV and AIDS, and is one of the few countries in the world which has been successful in reversing its HIV epidemic and achieved near universal access to HIV/AIDS treatment. This was achieved through targeted prevention programs that increase awareness of transmission and promote condom use, and the expansion of comprehensive care and treatment services throughout the country.

A 1999 external review of the UNICEF Mekong Region STD/HIV/AIDS Project concluded that:

“The Project has been successfully implemented and made valuable contributions at both country and inter-country levels to strengthen the capacity of a range of partners to respond more effectively to STD/HIV/AIDS prevention and care needs. Project implementation has been well managed and technical guidance has been good at all levels of project implementation. Activities undertaken have been appropriate, well designed and delivered, consistent with national priorities and responsive to emerging trends in the epidemic, and can be demonstrated to have considerable impact and have the potential to be sustainable. UNICEF’s commitment to collaborate with a wide range of national and international partners means that the effort is not isolated and has had an impact on, and benefited from the programming approaches of other agencies.”  

677 (3)
A happy, healthy Cambodian mother and child

Since that time, Cambodia has made substantial progress in preventing and mitigating the impact of HIV and AIDS, and is one of the few countries in the world which has been successful in reversing its HIV epidemic and achieved near universal access to HIV/AIDS treatment.

This was achieved through targeted prevention programs that increase awareness of transmission and promote condom use, and the expansion of comprehensive care and treatment services throughout the country.

Despite Cambodia’s success in controlling the HIV epidemic, more must be done to maintain the momentum in combating the spread of the virus, especially among the nation’s most vulnerable and marginalized populations, which include women, children and young people.

 

Hawai’i – The Perfect Refuge

 I returned to Hawai’i in June 1998 after two and a half years with UNICEF – six months in Fiji and two years in Cambodia. The East-West Center in Honolulu graciously provided me with an office to edit 20 years of personal journal entries while contemplating my next adventure.

My former landlords also welcomed me back to a quiet, refurbished top floor apartment – with spectacular views up to steep mountains and deep valleys, misty with passing showers and rainbows, and down to the sea, sunsets and the lights of Waikiki.

Biking to the beach each morning in the cool of the dawn just before the sun appears over the hills, a brisk swim out to the reef and beyond refreshes body and spirit. Moving through crystal clear water with the fish, sea turtles, and an occasional eel or ray. Then, seated with a cup of coffee under the coconuts in the morning sunlight – steady breezes under clear, blue skies, watching the surf roll in – indulging the artist’s lifestyle.

Sunset_next_to_Waikiki_Beach,_Oahu,_Hawai,_USA1
Sunset at Kaimana Beach near Waikiki, Oahu, Hawai’i, Wikimedia Commons

As 1999 dawned, I joined a friend for six weeks of travelling in Thailand, Indonesia – and Vietnam, where I would soon enter the next chapter of fun, adventure and serendipity.

Stay tuned for more stories, coming soon!

You can read more about Jim’s backstory,  here and here.

 

 

Biting the Dust in Cambodia (Part Two)

December 1997: “Stretched out along the banks of the mighty Mekong, the weather in Phnom Penh is fantastic this time of year. Sunny and breezy, all is green following the rains. The mud-slide streets have dried up and the choking dust and oppressive heat won’t come into full force for another month or so. Most importantly, the city is quiet – for the time being at least. Some fighting resumed in the northwest of the country, but we are back to the calm after (or before?) the storm. One never knows what to expect in Cambodia!”

1f cb-map

Civil War

During the months leading up to the fighting in July you could feel the increasing tension in the air. As usual, either utter doldrums of boredom in the blazing heat, with the usual annoyances, or life would suddenly get quite thrilling – as we listened intently for the steady bursting of shells. The situation was the worst it had been in some time.

The stalls in the local vegetable market were empty. My neighbor and I made a last dash to the nearby 7/7 shop and managed to score the few remaining basic food items and bottles of drinking water off the bare shelves before the owners closed the doors, locked the gate, loaded up their motorbike and headed out of town.

All but one of the banks had closed – and it was mobbed with people standing outside with bankbooks in hand watching the lucky ones in front receive hundreds, fifties, twenties, tens, fives, ones, and then, out of cash the bank simply closed its doors, leaving us all standing there with our worthless bankbooks.

Most of the foreign nationals were evacuated from the country. However, many of the international NGOs and United Nations staff remained during and after the fighting. It just so happened that both of my passports – diplomatic and USA national – were in government offices getting visas renewed when all this happened, so even if I could have left the country, I couldn’t travel anywhere. So we waited at home – shelling all day. My landlord’s family stayed too, and was wonderful with food and mutual support throughout.

636 (2)
My Phnom Penh apartment owner, Madam Vong

One of the areas of heavy fighting was near the UNICEF office (and near my apartment!)  Fortunately, the automatic weapons fire and heavy artillery were aimed away from my place.  We were instructed to stay at home – I was literally under the bed and tuned to the two-way radio handset while the fighting swept by.

Others were not so fortunate.  People were killed, and many homes and businesses were either destroyed by the fighting, or cleaned out by widespread looting by roving gangs of drunken young men toting AK 47’s.

Many people fled to the countryside, and the deadly political purges followed. Sadly, just around the corner from the UNICEF office, two children were blown up by a hand grenade they found lying on the ground.

599l1

After the event, there was an overwhelming and pervasive feeling of depression. Jobs disappeared as investors and foreign aid agencies pulled out. All that had gone towards establishing some form of stability, law and order and a semblance of hope in Cambodia seemed lost.

Eventually, shops re-opened, and investment slowly trickled back into the country, but the economy remained weak. Tourism largely ground to a halt. So if you were planning a visit to Cambodia,  you would have the beautiful temples of Angkor all to yourself!

The international airport had also been significantly damaged by the fighting, and was closed for several days. And until repairs could be completed, it was prudent to schedule morning flights to Phnom Penh when the weather was more likely to be clear, because pilots had to rely on visual navigation only, to land at the international airport. When I eventually got my passports back, I had new visas that allowed me to stay in Cambodia for another year – a comforting thought!

The Mekong Region STD/HIV/AIDS Project

On top of all this Cambodia had the most serious and rapidly progressing HIV/AIDS epidemic in Asia, and was on the brink of becoming one of the worst affected countries in the world.  HIV infection rates among sex workers, their clients and pregnant women were the highest in Asia. Nearly half of all brothel workers were infected, and the HIV infection rate among pregnant women had doubled since the previous year.

599p2

Commercial sex was cheap and widespread – an estimated 50,000 commercial sex contacts occurred each day in Phnom Penh, and with inconsistent condom use.

670 (3)
Cambodian girl receiving job training after being rescued from a brothel by a local non-profit organization

Under its humanitarian mandate, UNICEF continued working for the benefit of women and children in Cambodia, including the training of over 10,000 primary and secondary school teachers and curriculum writers on Life Skills approaches for HIV/AIDS prevention, along with a learning package for foreign language schools.

599t
Students in a UNICEF-supported ‘floating school’ on the seasonally inundated Tonle Sap freshwater lake

UNICEF supported multi-sector prevention activities at provincial level as well as community-based care and counseling for people living with HIV/AIDS. One such activity was later designated as a UNAIDS “Best Practice” model, which successfully brought together a dozen NGOs, and the Buddhist temples in Phnom Penh – all working in support of the municipal health services.

UNICEF also played a leading role in the first ever National Strategic Planning effort to identify priorities and key strategies to guide the response to the spread of HIV/AIDS in Cambodia.

Don’t Bring AIDS Back Home

UNICEF’s mass media social marketing campaign “Don’t Bring AIDS Back Home” had become the most popular HIV/AIDS prevention theme in Cambodia.

Cambodian women are especially vulnerable to HIV, in part due to cultural norms that tolerate men who seek sex outside of marriage and return home to have unprotected sex with their wives. Although the country’s epidemic was largely male-driven, it was increasingly infecting more women, with more than half of the new infections among women, and implications for increased mother-to-child transmission of the virus.

717a
Young people were closely involved in development of appropriate HIV/AIDS prevention messages and IEC media

Based on recent studies of sexuality among young people in Cambodia as well as our own participatory research with key target audiences, UNICEF worked closely with young people to produce appropriate IEC (Information, Education and Communication) media, including a series of interactive teaching video packages which presented real-life scenarios and modeled practical strategies for dealing successfully with a variety of risk situations.

Some of the videos were so popular, they were pirated and distributed even before being completed. These video packages were also adapted for use in Thailand, Laos and Vietnam.

714a
Empowering young people through Life Skills education

Behavior modelling and Life Skills educational programs aimed to empower young people to deal effectively with their problems, make choices, act on their decisions and protect their health when pressured to take illegal drugs, engage in unprotected sex or participate in dangerous activities.

For example, working with adolescent boys hanging out at snooker clubs, and who also visit brothels, UNICEF staff helped them identify a typical risk scenario, draft some basic scripting, and even act in the video – often featuring the peer group leader clearly modelling safer behavior at the brothel – in this case, insisting that they all use condoms.

Another scenario targets adolescent girls with example dialogue and behavior to effectively and amicably delay the onset of sex, when pressured by their boyfriends.

599q
Police were an important target audience for “Number One” condom promotion in commercial sex settings

Popular TV spots featuring famous Khmer actors also demonstrated safer behaviors. For example, married men who go out with their friends to drinking establishments where the waitresses or ‘beer girls’ also sell sex, are reminded to remain faithful to their wives or otherwise use a condom every time.

On one occasion, our popular film star disappeared with the ‘beer girl’ actress after the TV spot filming was over. We could only hope they were using condoms!

Stay tuned for more stories, coming soon!

You can read more about Jim’s backstory,  here and here.

 

Biting the Dust in Cambodia (Part One)

December 1996: “A weekend retreat — traveling three hours by convoy for safety, radios in each of the three cars and along a good, tar-sealed road (which passes through Pol Pot territory – and a popular kidnapping area lined on either side with mine fields) brings us to some very pleasant beaches along Cambodia’s southern coast. Then, during a morning jog along the beach, someone discovered a freshly killed, bloody corpse (probably a smuggler) the day we left the resort town Kompong Som. A stark reminder that we are still in Cambodia – where at times life can seem cheap, and security must be taken seriously.”

In May 1996, I moved to Phnom Penh, Cambodia to set up and manage UNICEF’s country program assistance to government, NGOs and international organizations as part of the Mekong Region STD/HIV/AIDS Project, a new regional project implemented in six countries bordering the Mekong River: Cambodia, China, Laos, Myanmar, Thailand and Vietnam.

The-Greater-Mekong-Subregion-GMS Researchgate
Greater Mekong Sub-region, by Research Gate

Still reeling in the aftermath of the Khmer Rouge’s reign of terror that led to the deaths of nearly a quarter of the population through execution, torture, starvation, and disease, Cambodia was, in the mid-90’s experiencing the most serious and rapidly progressing HIV/AIDS epidemic in Asia, and was on the brink of becoming one of the worst affected countries in the world.

1f cb-map
CIA World Fact Book

For the majority of Cambodians, HIV/AIDS was not considered a priority concern. Disruption and weakening of the family and community, as well as continued armed conflict and extensive poverty following years of turmoil had resulted in large numbers of young people, women and children living in especially difficult circumstances.

599o1
Cambodian countryside

The rapid transition to a free market economy, increased population mobility, the opening of borders, and other liberalizing measures implemented with little apparent guidance or regulation were also contributing to the explosive spread of HIV in Cambodia.

616 (2)a
Phnom Penh street traffic, mid-90’s

The primary mode of HIV transmission was unprotected heterosexual intercourse. Women especially faced an enormous challenge from HIV. National HIV Sentinel Surveillance had found that over 40% of the commercial sex-workers tested and nearly 2% of pregnant women attending ante-natal clinics were HIV-infected.

599h4
National HIV/AIDS Program  targeted prevention messaging and condom promotion 

Even among those who were not occupationally exposed in Cambodia’s growing commercial sex industry, women were increasingly at risk for infection from their husbands and boyfriends.

UNICEF’s chief strategy was to raise the capacity of counterpart organizations at local levels, working in collaboration with target populations assessed to be most vulnerable to sexually transmitted diseases (STDs) including HIV.

These included students in primary, secondary and vocational schools, non-formal education participants, out-of-school youth, women of reproductive age, women and children directly affected by HIV/AIDS especially rural people and ethnic minorities who faced a higher risk for HIV infection because of their marginal status.

599k2
The Khmer Rouge planted coconut trees throughout the capital Phnom Penh to impart a ‘rural utopia’ image.

Because so many of the educated Khmer had either died, were badly traumatized, or had fled the country to escape the horrors carried out by the Khmer Rouge under Pol Pot, the few remaining qualified government counterparts UNICEF could work with were stretched to the limit and often unavailable as they faced enormous challenges of competing priorities in health, education, social welfare, and other sectors that UNICEF supported.

Project Officer for STD/HIV/AIDS

As UNICEF’s Project Officer for STD/HIV/AIDS, I was responsible for overall planning, development and management of technical and financial assistance on all aspects of Project implementation to establish Cambodia’s component of UNICEF’s Mekong Region STD/HIV/AIDS Project.

599z2
Conducting situation analysis, needs assessment and awareness-raising on HIV/AIDS throughout the country

Through on-going situation analysis, awareness-raising, human resource needs assessment and training, the Project raised the capacity of government agencies, NGOs, local communities and the UNICEF country office to design, test, implement, monitor and evaluate activities to reduce HIV/AIDS transmission and increase community acceptance and care for women, children and families affected by the illness.

As the leading multilateral agency supporting Cambodia’s National HIV/AIDS Program and its multiple  implementing partners at national, provincial and community levels, a major challenge was trying to coordinate these efforts for maximum impact.

642_0001b
International Youth Club Pool, Phnom Penh

A swim each evening at the International Youth Club pool was refreshing and helped ease the strain, followed by a bowl of noodle soup from my favorite street vendor and a loaf of hot, crispy French bread from the ‘Nom Pang’ (bread) vendor whose ‘Pang Pang’ cries echoed through the streets as he peddled his bike through the night.

630 (2)
My favorite noodle soup vendors, Phnom Penh

Of course, it was prudent, especially after dark, to carry a readily accessible $20 bill to hand off in a hurry if confronted by armed robbers roaming the streets.

614 (2)
Some of the exquisite French-colonial era architecture

Once known as the “Pearl of Asia,” Phnom Penh was considered one of the loveliest French-built cities in Indochina in the 1920’s. Sadly, in the mid-90’s, the city was a stinking mudslide when it rained, and a heavily trashed dust bowl the rest of the time, especially because of the growing traffic on the largely unpaved roads.

735 (3)
Many of Phnom Penh’s streets were unpaved and badly trashed

Of course, a big challenge was simply managing the energy drain and overall depressing nature of the place. Rampant corruption, civil war and subsequent political purges, AIDS, poor illiterate peasants, beggars, amputees, child prostitution, orphans – it was going to take time to recover from such horrific trauma and suffering.

619 (2)
Not much to buy or eat

Strolling home from the pool each night under the stars, twinkling through the coconut palms – down the quiet, dusty back streets, a few fires burning in the darkness, migrant workers and their families huddled in ramshackle shelters.

A few guys shooting snooker, a scuttering rat or two in the rotting rubbish piles and stagnant pools of stinking water, past a small market area behind the crumbling hospital next to a temple.

002d
Exuberant Cambodian Children

But as usual, there was not much worth buying or eating – except a roast banana or perhaps a blackened rock-hard baguette from the mobile hot bread-seller.

Again, the positive and stimulating nature of my work at UNICEF is what saved me. And thank goodness for the pool, and for walk-able streets, and the stamina to respond to the swarms of kids desperately seeking attention and love, and somehow, still bursting with boundless youthful exuberance.

Stay tuned for Part Two, coming soon!

You can read more about Jim’s backstory,  here and here.

Kava Kava

Author’s Note: It was such a great year – finishing my doctoral fieldwork in Thailand, defending my dissertation, graduation, sailing the South Seas and getting off the boat to begin a six-month consultancy with the United Nations Children’s Fund (UNICEF) Pacific Regional Office based in the Fiji Islands. After a long fruitless job search, it was my first big break back into the working world after half a dozen years in graduate school.

UNICEF Pacific Islands works with the Cook Islands, Fiji, Kiribati, Marshall Islands, Federated States of Micronesia, Nauru, Niue, Palau, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu and Vanuatu. These 14 countries and territories are home to about one million children under the age of 18, living in more than 660 islands and atolls covering an area the size of the US and Canada.” United Nations Children’s Fund (UNICEF) Pacific Islands.

Map of the Pacific by UNICEF Pacific
Countries and Territories of the Pacific

The New Year 1996 began in the Fiji Islands, at UNICEF’s Regional Office for the Pacific. I was on a consulting assignment to investigate the impact of rapid social change on Pacific Island youth, with particular reference to substance abuse (alcohol, tobacco and Kava), and the implications for related issues such as violence, crime, unemployment and sexual risk behavior.

In collaboration with the World Health Organization (WHO) and the Australian Agency for International Development (AusAID), UNICEF Pacific Islands organized and hosted a regional “train the trainer” workshop for government, non-governmental organizations (NGOs) and community leaders from 14 Pacific Island nations to share experiences and develop targeted health promotion and prevention initiatives.

676a
Participants in the Regional Workshop, Nadi, Fiji Islands

Far from uplifting, the drug and alcohol work was a welcome break from HIV/AIDS which had been the focus of most of my work in recent years. It was also a refreshing change to be tackling the complex issues related to misuse of alcohol, which are often overlooked, as responsible alcohol consumption is common and widely condoned, and yet at times, also abused, including by those tasked to address alcohol-related problems.

Participants from a range of NGOs and government ministries were in positions to lead on addressing these issues in their home countries. But the severity of the problem was brought starkly to the fore when an alcohol-related sexual assault occurred at the workshop, perpetrated by one of the delegates supposedly tasked to address these issues in his home country.

678a
Workshop participants enjoying an ‘alcohol free’ break

On the positive side, important outcomes from the workshop included establishment of laws regulating two key areas of alcohol marketing to reduce its impact on Fijian youth. First, the logo of Fiji’s popular local beer “The Sportsman’s Beer” was changed to “Ahh Your Beer.”  Second, all advertising of alcoholic beverages was banned from sporting events in Fiji both of which associated alcohol with youth sports.

The downside was that beer banners flying at sports stadiums were replaced with non-alcoholic, sweet fizzy drinks – which entail their own health problems, particularly obesity. But at least they were promoting an alternative to alcohol.

677a
Jim with some of the workshop organizers

Kava is consumed widely in many Pacific Island communities both socially and ceremonially. The locally produced and culturally valued beverage ‘Kava’ is also promoted as a healthier alternative to alcohol. Some of the local churches even promote Kava use over alcohol.

Known as yaqona or simply grog in Fiji, Kava is a mildly narcotic drink made from mixing the powdered root of a species of pepper plant with water and results in a numb feeling around the mouth, lips and tongue and a sense of relaxation. It is also an important export crop within the Pacific from major producer countries (e.g. Fiji) to other countries in the Pacific, and as an ingredient for some health supplements and pharmaceutical products sold in Europe and the U.S.

051 (2)
Fijian visitors to Samoa are being served Kava as a part of a traditional welcome ceremony for special guests.

Kava is cheaper than alcohol, and thus less likely to be a drain on household finances. There is little scientific evidence of harm to physical health from drinking all but extremely large amounts of Kava. Both men and women typically drink it together in social gatherings.

Violence or assault, which can be associated with alcohol misuse, are much less common – especially sexual assault, due to Kava’s effect as a sedative and muscle relaxant (so it is not possible from the male standpoint!) And when the drinking stops, the usual result is simply to fall peacefully to sleep.

695a
Village kids on Moala Island in the Lau Island Group, Fiji

During this time, I joined two WHO consultants to conduct a regional study on alcohol consumption in the Pacific, and published the findings in the journal Drug and Alcohol Review. Data were gathered in the Cook Islands, Fiji, Kiribati, Samoa, the Solomon Islands and Tonga, and were reported along with a discussion of the nature of alcohol-related problems in the island nations.

Per capita consumption was found to be highest in the Cook Islands, which compared with other countries had the highest ratio of liquor outlets and lowest alcohol taxation regime. As an alcohol prevention measure, it was concluded that the promotion of responsible consumption, together with the option for abstinence for those who wish it, is an acceptable strategy for the Pacific.

166
Catch of the day!

After completing my consulting assignment with UNICEF, I agreed to assist Rob Kay, author of several popular Pacific travel guidebooks  (including the online “Fiji Guide”), to update his latest edition of “Fiji: A Travel Survival Kit.” My research on Kava had taken me to some of Fiji’s more remote outer islands anyway, so I was able to visit tourist and traveler destinations in these places for the updated guide book.

In such a small country, everyone at these places would know Rob, but not me, so my reporting was more likely to generate an unbiased opinion about the quality of food, accommodation and service at these resorts.

693a
Village view, Moala Island, Lau Islands, Fiji

Flying Sunflower Airlines to the far-flung Lau Islands of Moala and Vanua Balavu to the east, then by ferry to Kandavu Island in the south, pampered at times in 5-star resorts, I took detailed notes by hand-held recorder on the quality of the food, general accommodation, room décor, bedding, and service, etc. Elsewhere, I sweltered in ‘prison-cell-like’ ‘budget’ backpacker accommodation.

190h
Touring the rugged interior of Viti Levu Island, Fiji

In the rugged interior of the main island of Viti Levu, I joined some of my former colleagues from the Fiji YMCA for some four-wheeling along ridge tops in the setting sun and through swollen rivers of Sigatoka Valley.

171 (2)

On to the Coral Coast, and then to Taveuni Island, I went scuba diving on the famous ‘white wall’ of live coral. Swept along with the strong current and entranced by the passing circus of colors, I lost track of my depth and suddenly realized that my dive partner was far above me – as I drifted deeper and dangerously into the early stages of nitrogen narcosis! Fortunately, I came to my senses in time to rejoin my dive partner at a safe depth.

720 (2)a
Farewell Fiji – until we meet again!

The job networking finally paid off when someone I had met at a regional HIV/AIDS conference in Thailand contacted UNICEF Fiji and offered me the STD/HIV/AIDS Project Officer position with UNICEF, Cambodia!  I would soon be a full-time ‘expat’ again!

Despite all the fun and exotic travel around Fiji, I was  pretty burned out, and ready for a change. The pervasive health and social problems of alcohol misuse, drugs and HIV/AIDS were wearing on me a bit. But it was all still rolling along, and now I was headed back to Asia, and to all that Cambodia had to offer, including: Pol Pot, poverty, civil war, corruption, beggars, amputees, HIV/AIDS…

Stay tuned for more stories, coming soon!

You can read more about Jim’s backstory,  here and here.

 

Abandoned Children and HIV/AIDS in Northern Thailand (Part Two)

Author’s Note: In 1993, during the peak years of the HIV/AIDS epidemic in Thailand, I planned and conducted an independent investigation on child abandonment and HIV/AIDS in northern Thailand, as part of my doctoral program at School of Public Health, University of Hawai’i at Manoa, with support from the East-West Center research institute in Honolulu, USA, UNICEF Thailand, and Mahidol University School of Public Health in Bangkok.

The fieldwork incorporated epidemiological and anthropological methods as well as participatory urban and rural appraisal techniques over a nine-month period. I applied computerized data analysis to assess the nature and magnitude of problems within a context of rapid social and economic change, and proposed options for prevention and community based management of abandoned children. The findings were published in a major collaborative study to assist national and regional planning and policy development.

Chiang Mai

Across from Central Shopping Complex, my apartment in Chiang Mai, Thailand’s second largest city, was new and comfortable, if a bit sterile. But the rent was cheap, the building was clean and a public pool was just a short walk away – through choking, dust-filled, traffic snarls.

It also happened to be home to a host of local ‘kept’ women – the ‘minor wives’ (mia noi) of wealthy Thais, their Mercedes and BMWs regularly arriving to pick up and drop off these beautiful women, in some instances with small children – comprising ‘second families.’

My other hangout was a public health station on the outskirts of the city where I was hosted by a community health nurse and her son in a peaceful, rural setting, but within a short pickup truck ride to the city. As many of the peri-urban districts near Chiang Mai, ours had been hit hard with HIV/AIDS and was therefore one of my primary data collection sites.

578 (2)
“Yao”, a community health nurse at her district health station near Chiang Mai, Thailand

Almost daily, and for months, local funeral processions made their way to the crematorium directly across the road from our health station. The men were dying from AIDS, and tragically, it would only a matter of time before their wives and girlfriends would follow.

In one neighboring sub-district, fully 30% of pregnant women had tested positive for HIV. These women, as so many others like them, had been infected with HIV by their only sex partner – their husband. Widespread unprotected sex in the many commercial sex venues frequented by single and married men was the principle driver of the epidemic.

In many cases, the husband was already dead – the child as well, and many of these young housewives would be left utterly alone – rejected by neighbors, friends and family, and unable or unwilling to safely confide in anyone except the local health worker or counselor due to the widespread fear and stigma towards people infected with HIV.

Others, particularly the poor who worked in the widespread commercial sex industry would eventually die as well. Having lifted their families out of poverty – a nice home, perhaps a new pickup truck parked out front – but the daughter (or son) was dead.

579ab
Conducting field visits in northern Thailand where HIV/AIDS was ravaging the countryside.

It was devastating, and I was forever humbled by the tireless dedication of the many fine individuals in the medical, social welfare and counseling professions – including Yao, the most junior of the eight community health nurses assigned to her health station. She was often the only one who would provide home care for people living with HIV and AIDS, and eventually was the only one who would close the eyes of the deceased.

She also quietly supplied the local ‘gay’ temples with condoms – and tried unsuccessfully to convince the local Abbot, a respected figure – and HIV positive – to ‘come out’ to promote better prevention. Buddhist temples have traditionally taken in young boys as novices, often from poor families wanting a better future for the child, including free education, shelter and financial support.  But without proper oversight, sexual abuse has become a reality, both among the older and younger novices as well as between monks and novices.

However, as the epidemic progressed,  many Buddhist temples also became important refuges for the HIV-positive homeless – who had been rejected by their families, and hospices for end-of-life care for people living with HIV and AIDS.

Land of Smiles

Back at the apartment in town, my neighbor Bill was seated in the downstairs lounge reading a paperback, his hulking mass squeezed into a lounge chair – waiting, as always for his phone to ring with the next job.

A former coal miner from somewhere in northern England, he now made a living running contraband between various Asian ports. His large, scarred head was covered with sparse patches of brown stubble. He looked up and flashed a cheerful grin through broken teeth.

“Off somewhere?” he asked.

“Headed to the beach for a few days – need a break from this madhouse, dust-ball of a town.” I replied.

“Good idea! I just got back from Japan – I’m set for money now.  But while I was gone, me woman and two of her friends hocked the TV and stole me clothes, me money…  Bloody headache the damned bitch.”

“Why do you put up with her?” I asked.

“Aw, she’s not a bad girl really. A hell of a lot better than the last one – at least here the girls treat a bloke with some decency.  Back in London if I say hi to a girl on the street she’ll tell me to fuck off.”

Orange Crush

My field research in Thailand was winding down, so Yao and I boarded an overnight VIP bus in Chiang Mai and headed south to Bangkok, and then to the beach. Out on the open road, the bus charged into the darkness of the night.

The air conditioner was turned too high and the video at the front of the bus was playing so loud it hurt.  When I went forward to ask the driver to turn down the volume, a collective sigh of relief followed among the mostly Thai passengers, as if to say “thank goodness that foreigner made the awkward request.” Thais typically avoid confrontation at all cost.

I tried to catch some sleep in the swerving bus as it hurtled through the night, but the headlights of on-coming traffic flashing by seemed much to close for comfort. Vivid scenes of wrecked buses along the roadside – sheered lengthwise – came to mind. Horrible road accidents were common on Thailand’s two lane highways, and the local orange-colored buses were jokingly known as “orange crush.”

Indeed, it was prudent to sit in the middle so as not to be crunched in the front or the rear, and on the opposite side to the on-coming traffic. I was seated in the middle, but on the wrong side and couldn’t sleep for fear of waking up with an oncoming bus in my face.

TrafficInBangkok Thomas SD Wikimedia
Traffic in Bangkok, Public Domain, Wikipedia Commons

Pulling into Bangkok’s early morning traffic, the day was already heating up into a stifling haze. The city groaned with the sound of vehicles – a gray urban skyline stretching out before us and disappearing into the haze. Then, crammed into a ‘backpacker special’ minibus for another overnight near-death experience at the hands of a reckless driver – miraculously we arrived safely in the southern town of Surat Thani.

Ko Tao Wikimedia, Roma Neus
Koh Tao in the Gulf of Thailand, Wikipedia Commons CC BY 3.0, by Roma Neus

Stretched out on the smooth salt and weather worn deck of a converted fishing boat,  we headed to the islands of Samui, and Pha-Ngan, and finally to Tao Island (Koh Tao), and soaked up three lovely days of pleasant, breezy walks through coconut groves and jungle-clad mountains, snorkeling in the clear, silky waters decorated with soft and hard corals, colored fish, giant manta rays, diving on a wreck, and enjoying plenty of fresh seafood. It was wonderfully refreshing to unwind a bit, and to get rested and healthy again!

Stay tuned for more stories, coming soon!

You can read more about Jim’s backstory,  here and here.

 

 

Abandoned Children and HIV/AIDS in Northern Thailand (Part One)

Authors Note: In 1992, the East-West Center, a federally funded research institution located on the University of Hawai’i in Honolulu awarded me with an academic  scholarship for four years of graduate study and field research towards the degree of Doctor of Public Health.

I was also recruited for a summer research project with the Thai Red Cross Society in Bangkok – interviewing street children, residents of crowded communities (a.k.a. ‘slums’) and social workers to assess the current and future impact of HIV/AIDS on children in Thailand, which also helped to refine the focus of my doctoral research project.

Klong Toey Slum, Bangkok

I met Lee at a public swimming pool near my apartment in Bangkok and she graciously offered to assist me with my summer research project. Her excellent English, keen interest in HIV/AIDS and wonderfully supportive and cheerful companionship were a real boost.

416
My research Assistant ‘Lee’, with the Thai Red Cross Society

Riding hot crowded buses roaring through the capital city’s choking air pollution and notorious traffic to and from work, our days were spent conducting interviews in the hot, stifling crowded urban slums. Built on a swamp, Bangkok’s largest slum “Klong Toey” is home to over 100,000 residents, crammed into roughly one square kilometer of sludge, rubbish and sewage. Many of the tin-roofed houses are on stilts over stagnant, polluted water, and the area is prone to flooding particularly during the monsoon season.

Klong Toey Slum Dwellings by The Thinker 1
Slum dwellings, Klong Toey, Bangkok, AsiaThinkers

Seated cross-legged on the floor, there was an easy-going village feeling even in those cramped urban quarters as most of the residents were poor rural migrants who had come to the city to find work. The latest fad among the youth was glue sniffing and many we came across were lost in a glue-fume stupor.

585
Klong Toey Slum, Bangkok, Duang Prateep Foundation

Balancing on rotting boards above the stinking swampland, we made our way along the narrow, broken walkways.

Then one day when we arrived a crowd had gathered to receive soap and rice from a local relief agency – twenty percent of the slum had burned to the ground the previous night. Two hundred eighty families suddenly homeless – no food or money, everything lost. A young sex worker we interviewed echoed the sentiments of many of the slum residents: “Of course, AIDS can kill you in a few years, but I have to feed my family today.”

A late afternoon downpour jammed the traffic to a standstill. Walking was going to be faster than to creep along in a sweltering traffic snarl, so we hopped off the bus and ducked out of the rain and into a food stall for some soup to wait out the storm.

genteng by Asia Thinkers
Klong Toey Slum, Bangkok, AsiaThinkers

At home, a cold beer washed down the urban residue. Sharing some late season sweet mangoes, sticky rice and coconut cream, Lee rescued me from my self-destruction and despair and helped translate our taped interviews with social workers, sex workers and drug users.

Yes, all of this and Willie Nelson (“Blue Skies”) on the radio helped put a guy in a jolly mood.  It was really getting better, as long as I didn’t go insane! A final trip to the beach left us tanned and refreshed. And at last a focused dissertation topic on a meaningful and pressing issue was finally materializing.

Abandoned Children and HIV/AIDS

With the course work finally done, and my ABD “All-But-Dissertation” certificate in hand, I departed Hawai’i in July 1993 to begin nine months of independent field research in northern Thailand to examine the factors underlying the recent escalation of abandoned newborn infants in the northern city of Chiang Mai, with particular attention to the rapid spread of HIV, which was devastating the northern part of the country.

Using participatory urban and rural appraisal techniques to assess the magnitude and nature of problems within the context of rapid social change, the research aimed to inform effective policy and planning to address the underlying conditions within which child abandonment was occurring — including options for prevention and community-based management of abandoned children.

Thailand-CIA_WFB_Map_(2004)

The precise number of children abandoned in Thailand at that time was not known, although estimates based on institutional data suggested that more than 2,000 children were abandoned each year in 17 northern provinces – some of the poorest parts of the country.

But this was likely just the tip of the iceberg, as survey research had also found increasing trends of child abandonment by their mothers in hospitals shortly after delivery, as well as children born elsewhere and later deserted at hospitals. At that time, just one quarter of those in need had access to child welfare services.

When I began my research, there was one orphanage in Chiang Mai, Thailand’s second largest city. But within a years, the number of orphanages had grown to six to manage the growing number of abandoned children.

As young people were increasingly moving to towns from their home villages for work or school, the risk for unintended pregnancies increased dramatically among the unmarried young, often poor women who were then being left alone by their partners when becoming pregnant.

So, it was in desperation that these women — typically poor, alone and too ashamed to return to their village as a single parent — would present for an emergency delivery and then escape, leaving the baby on the table. Far from being a malicious act, her rationale was that the clean, modern ‘baby home’ or hospital would surely be able to provide a better future for her child than she could.

Orphanages or “Baby Homes’ typically cared for orphaned boys and girls up to age five. But by age six, the orphaned girls would all have been adopted, leaving only the boys in what are called ‘Boys Homes’ until they are old enough to legally go to work.

Interestingly, baby girls were more highly coveted than boys by Thai adoptive parents — typically older, their own children grown and gone. A girl was considered less trouble than raising a boy, and also more likely to stay home to take care of the parents in their old age.

Stay tuned for Part Two, coming soon!

You can read more about Jim’s backstory,  here and here.

Back to School: Alaska (Part Two)

Author’s Note: “The Alaska Native Health Board (ANHB) is the statewide voice on Alaska Native health issues. Active for over 40 years as an advocacy organization for the health needs and concerns of all Alaska Native people, ANHB continues to emphasize the importance of self-determination in healthcare services and encourages wellness and healthy ways of life in Native communities through policy change.” ANHB Website

In August 1990, I began my Master of Public Health (MPH) graduate program at the School of Public Health, University of Hawaii, USA. The following summer, I headed off to Alaska for my field research project, working with the Alaska Native Health Board to study and produce an analysis of issues, policies and programs affecting Alaska Native health.  The document served as the initial briefing paper for a joint Federal and State review of the geo-political, economic, environmental, cultural, psycho-social and other critical issues affecting Alaska Natives.

Field Research

Buckled in next to the pilot in a two-seater helicopter, we flew to a gravel strip alongside the scant row of houses on a wide bay across from the Kenai Peninsula. Port Graham – an Aleut village of 200 people, was hosting a first-ever youth ‘Spirit Camp’ organized by the Alaska Native Health Board, with 30 teenagers from seven communities participating.

211a
Flying into Native communities in Southeastern Alaska

It brought back wonderful memories of my YMCA youth work over the years in the USA and abroad. Led by Don, a gifted and charismatic Native youth leader, they addressed the various pressing social issues and youth concerns with creative and engaging activities and discussion, including a powerful drama performance on the problems of alcohol abuse.

Flying north to the village of Kotzebue above the Arctic Circle in ‘the land of the midnight sun’ we watched the sun drop to the horizon to the west over the Bering Sea and then rise again – never setting. Then, by car we followed the gravel road through a wide and lonely expanse of low-lying hills to Nome where I was hosted by a local family and their 16 sled dogs.

234
The road to Nome, Alaska

Driving on to the village of Teller, we picked salmon berries, learned about ‘honey buckets’ from the community health workers and then drove to the end of one of the few remaining roads in this part of Western Alaska, through spectacular rolling hills, past sparkling clear streams draining distant snow peaks and emptying out into the Bering Sea to the west.

221

Then following a hectic week back in Anchorage typing up field notes on the computer, we flew to the sizable community of Bethel, located on the Kuskokwim River in Western Alaska to visit their hospital aptly named the “Yellow Submarine” due to its tubular shape and color.

225
Approaching the Yupic Eskimo village of Kipnuk

Continuing by light aircraft from Bethel, we flew over vast stretches of barren, misty tundra to Kipnuk village on the Lower Delta Region of the Kuskokwim River where we were searched for drugs upon arrival, except for one passenger who refused to be subjected to the search and left immediately on the return flight.

226a
Search House at Kipnuk village airport

One by one, the rest of us were taken into a small shed next to the airstrip where we were instructed to remove our outer garments and footwear while the official went through our bags – including my notebook page by page – apparently looking for ‘micro-dot’ doses of illicit drugs.

Each of the 229 federally recognized tribes in Alaska is essentially a separate ‘sovereign’ entity or ‘nation’ with the right to make their own laws and be governed by them. As such, local tribal ordinances in some communities have mandated thorough searches of passengers on all in-coming flights. These procedures are viewed as an essential part of the on-going battle to keep drugs out of their communities.

227a

The tiny shamble of roughly built, weather-beaten wooden houses sporting TV satellite dishes punctuated an otherwise barren landscape. A solitary child rode his bike along the small patchwork of village boardwalks that straddled a sea of rubbish immediately below. The flat, mushy summer tundra stretched as far as the eye could see under the cold, misty grey sky.

219Flying on to Alakanuk village on the Lower Yukon Delta we enjoyed spectacular scenery by light aircraft – flying over thousands of mirror-like ponds and squiggly waterways flowing through the multiple shades of greenest tundra feeding the Yukon-Kuskoquim Rivers and flowing out to the Bering Sea and on to Siberia.

220a
Alakanuk City Health Center ‘leased’ to the US Department of Health, Education and Welfare

An occasional white tent marked a riverside fishing camp. Moose and herds of Caribou moved across the vast expanses stretching to the horizon.

229a

Anchorage

By mid-August, the first snow had dusted the earth. In just one more week, I would be enjoying Hawai’i’s balmy breezes and inviting seas. But it was time to decompress. 223a

Travelling around the state and meeting everybody for interviews was extremely exhausting and stressful, and the whirlwind trip had taken its toll on my health. I had come to the conclusion that short-term intensive consultancies were probably not for me.

Just short, quick investigative visits in and out of a given community, but still expected to somehow absorb a sufficient understanding of the often complex situations. I also missed the sense of a longer term commitment to the place and the people as I had experienced on longer-term projects, like in Samoa and Thailand.

But overall, it had been an extraordinary experience – very special. And I hoped that my input would result in a useful contribution towards addressing the formidable and on-going challenges affecting Alaska Native health.

216Indeed, the people I met were exceedingly warm and gentle, and perhaps the most spiritual people I had ever known. When asked to describe themselves, it was always a ‘circle’ – balanced and in harmony with the universe.

But it was time to leave Alaska, and I enjoyed my last bike ride in Anchorage along the coastal trail between rain showers, breathing in the rich, moist, cool and invigorating air, alive with green growth.  I would miss it when the sun is out, but not the damp chilling rain, or the blustery north wind whipping across cold grassy marshes.

233 (2)
Spectacular scenery flying over Alaska’s interior

All so very beautiful – wildlife roaming freely. But I was ready to get back to warm sea breezes and refreshing morning swims in Hawai’i’s clear, sub-tropical waters. At last, handing over the document — with glowing evaluations from the Alaska Native Health Board and the Alaska Federation of Natives — I was content and ready for a good rest.

The Crash

I felt it coming after returning from Alaska in August, and it all stopped abruptly after losing Nit in December – she had married a Thai. Then the parting of friends at graduation, coupled with having lost Jessie when she married the year before, which symbolized a severance from the perpetual high of the past decade or so. The high and wide wave I had been riding for the first 18 months back in the USA had finally crested and crashed.

Eventually, I began to come out of the long bout of depression, culture shock and life-phase re-evaluation. But the painful sting of lost relationships remained – the consequence of living a transient, temporary existence everywhere – and forever negotiating that fine line between stability and stagnation.

001

View of the University of Hawai’i at Manoa campus from my study room at the East West Center

So, at last it was back to the good life in Hawai’i – taking it all in. Three all-you-can-eat buffet meals each day, biking to the beach, swimming in the sea, stressed mainly from the busy social life, but most content to be in the library with my nose in the literature.

The view up into the mountains from my study room was spectacular. Misty, mid-morning showers brightening into rainbows, arching across the valley. Then suddenly, the semester was over, but more critically, the all-you-can-eat student meal plan was over as well! 

Stay tuned for more stories, coming soon!

You can read more about Jim’s backstory,  here and here.

Back to School: Alaska (Part One)

Author’s Note: In August 1990, I began my Master of Public Health (MPH) graduate studies at the School of Public Health, University of Hawai’i, USA. The following summer, I headed off to Alaska for my field research project, working with the Alaska Native Health Board,  an advocacy organization for the health needs and concerns of all Alaska Native people, to study and produce an analysis of issues, policies and programs affecting Alaska Native health.  The document served as the initial briefing paper for a joint Federal and State review of the geo-political, economic, environmental, cultural, psycho-social and other critical issues affecting Alaska Natives.

Alaska

State-of-Alaska-Map

It was time to tug on the muck-lucks, smear some whale blubber on my chin and head for the Klondike! Based in Anchorage for my Master of Public Health (MPH) summer field project with the Alaska Native Health Board, I traveled by road, sea, and air – including two-seater light aircraft with bush pilots to Native communities throughout the state. I met with tribal councils, visited village health clinics, and interviewed local health workers and their clients to gain a better understanding of the impact of public policies, programs and other critical issues affecting Alaska Native health.

Tlingit & Haida Totem at Village Park, Willoughby Ave, Juneau, Alaska.
Tlinget and Haida Totem by Gillfoto CC BY-SA 4.0 Wikipedia Commons

Anchorage is like a modern city with big, broad streets, some busy highways, but with a distinctive, wide open western ‘cow-town’ feeling. The local bars are dark, windowless holes underground with billiard tables and sawdust floors — an efficient escape for anyone wishing to detach fully from the world. Alcohol abuse is a devastating problem in Alaska and it was depressing to see this in an otherwise healthy environment.

Neatly paved trails wind through the well-planned, eco-friendly city, and offer cyclists or skiers — depending on the season — a pleasant and practical alternative to the main motorways. Breathing in the rich, moist, cool and invigorating air, I enjoyed daily bike rides through dense forest along Cook Inlet, named for the famous explorer Captain James Cook. Sharing the bike trail with an occasional moose grazing in the late afternoon sun dazzling across the water, the world was alive and fresh with lush, green growth everywhere.

249c
Cook Inlet, Anchorage, Alaska

Beautiful when the sun is out, but cold and damp in the rain, with the blustery north wind whipping across the grassy sea marshes at low tide. Long summer days, sunglasses on at 10 PM. The sun still high and glinting off the water with spectacular sunsets over the snow-capped Chagrach Mountain Range – splendid in the clear, fresh evergreen-scented forest.

June was a bit nippy for this island boy — 45-55 degrees F. At 60 degrees, painfully-white sun-bathers stretched out on a muddy beach were hopeful in the midday sun. But by mid-August it was snowing and I was ready to get back to Hawai’i’s tropical sea breezes.

209a
Bill at the Ninilchik Tribal Counsel Center, Kenai Peninsula

Weekends on the Kenai Peninsula with my friend Bill were refreshing getaways from work and the city. Half Athabaskan Indian and half Russian, Bill was typical of many Alaska Natives. Bill worked with the Indian Health Service in Alaska and was also doing his MPH at the University of Hawai’i School of Public Health. His cabin, which he had built himself, was one of the few buildings in his home village of Ninilchik.

The only other building in sight was a large, simple structure with a smoky all-night bar and country music dance hall on one side, and an 24/7 cafe/diner on the other. Separated by the bathroom, convenient transfers could be made from one venue to the other and back again, depending on the time of day or night.

So, it was exciting times in center-town Ninilchik Alaska, with mere hours between late night beer drinking with the sleepy country and western band and late morning coffee and breakfast in the attached diner. A one-stop, all-purpose gathering spot for local residents.

245
An abandoned silver mine south of Anchorage

Driving south from Anchorage past Portage Glacier, the town of Homer, also known as the “Halibut Fishing Capital of the World” was a total zoo with all the RVs, ‘shoestring’ budget campers and fishermen standing elbow-to-elbow along the Kenai River.

240 (2)
Traditional Alaska Native (Eskimo) Dancing

Bill took me to his family reunion and to several other Native potlatches – gift-giving feasts organized by indigenous peoples of the Pacific Northwest Coast of Canada and the USA. At these potlaches we enjoyed tons of tasty baked and smoked salmon, halibut, and seal meat, served up amid the splendid panorama of snow-peaked mountains with rivers rushing in spring run-off, and volcanoes rising across the inlet.

237a
Native song and dance groups from the “Lower 48” States

Colorful Native dancers moved to the mystical beat of huge drums at the annual ‘Spirit Days’ festival in Anchorage, which brings together tribal groups in traditional costumes from throughout Alaska and from the ‘Lower 48’ States.

249a1
Russian Orthodox Church

With the rain coming down, oldies playing on the radio, I was happy as a clam in my cozy rooftop apartment overlooking Cook Inlet. Away from academia, I was thoroughly enjoying my research project on ‘real world’ contemporary health and development issues, in a cross-cultural setting and all on my own time schedule. My only worry was that I might become too engrossed in it all and miss out on enjoying this beautiful place.

248b
Russian Orthodox Church entrance reflecting the traditional church patriarchy of a bygone era

Fortunately, I am totally addicted to swimming. So my daily bike rides along the coastal trail to the University of Alaska pool were not to be missed. It was simply magical pedaling along the coast through the pine-scented forest with the late afternoon sun dazzling across the water — draining the new green of the mudflats at low tide.

But the real fun began went I started my field work in Native communities throughout the state – travelling across vast, empty stretches of land and sea to tiny, remote and often stunningly beautiful locations to meet and interview local health staff and community members for my research project.

img182 (4)b
Old Harbor, an Aleut village on Kodiak Island, Alaska

Stay tuned for ‘Back to School: Alaska (Part Two)’, coming soon!

You can read more about Jim’s backstory,  here and here.

Back to School: Hawai’i

August 1990 “A big, red sun was setting over smoggy Bangkok as the plane took off — setting as my heart is sinking – wrenching pain to again leave and say good-bye to good friends, and to once again leave a beautiful girl behind. Parting with Nit for an uncertain future – am I making another mistake? At the same time still smarting with the awful hurt of losing Jessie the year before – shattering those dreams. When will I be able to settle on someone, to finally be content, satisfied? Wishing I had taken her with me when she so wanted to go… now just fond, bittersweet memories. Really wiped out, heart-broken, so tired of it all. On to Hawai’i – back to my own country; back to school. A timely change for this fried expat. Look forward now, and enjoy the memories.”

Thailand

The beach was windswept, empty and stretched as far as the eye could see. A ferry was tied to the pier, but the passengers had long since disembarked. No one was in sight. Had she gone off somewhere? If so, how would she find my bungalow – she didn’t know where I was staying.

Suddenly Nit appeared from behind a sand dune, looking somewhat lost and alone. A small travel bag, black satin trousers hanging high and loose around her ankles, the wind blowing in her hair.  I felt terrible. I was late getting to the pier, and had not been there when she arrived.

026a (2)
Nit on Chawaeng Beach, Koh Samui, Thailand

Our reunion was tender, but somewhat dampened, as I was to leave for school in America the following week. Nit and I had been living together in Bangkok for nearly a year, and we had been preparing for this for some time. There were plans for her to follow me to Hawai’i, but as is so often the case, plans fall through.

We didn’t know it then, but this beach holiday was to be our last one together. One week later I would leave, and that would be the last I would ever see her. It still rips my heart apart to think about it. Distance and too much time apart spelled the end, and she eventually married someone else in Thailand late the following year.

Hawai’i

In August, I began my Master of Public Health (MPH) studies at the University of Hawai’i, School of Public Health and moved in to an apartment with three other students – one was a friend from my Samoa days. He had been a Peace Corps Volunteer when I was there with the YMCA, and invited me to join their Hawai’i household.  What a privilege it was to have the time, resources and purpose to tie together some of my ‘real world’ experiences in a comfortable academic setting, which helped make sense of it all, as articulated and validated in research and stimulating discussions.

002a
View from Diamond Head Crater State Monument, Honolulu, Hawai’i, USA

It was to be another jam-packed year of incredible highs and some intense lows – the heart-wrenching parting of friends, some wonderful reunions, and riding an incredible wave since arriving in Honolulu – turn right for the University, turn left for the beach.

Indeed, it was a significant year of transition returning to ‘civilization’ after nearly a decade living in the comfort of the outside world. But Honolulu was a beautiful, clean, modern city with a friendly, relaxed atmosphere, a perfect climate, and mostly Asian and Pacific people living in the beautiful Hawaiian Islands. I was stayin’!

IMG_20200309_172158199 (1)So it began – my tumultuous re-entry into the Western world as this ‘primitive man’ so to speak, prepared to ‘leave the trees’ – as illustrated in a typical Far Side cartoon panel showing a cave man clinging desperately to a tree at the edge of the forest as a truck stood by waiting – presumably to take him to the city.

Again, I was in for some of the highest highs and lowest lows as I entered my graduate program at University of Hawai’i School of Public Health. Not least of which was an insidious ‘reverse culture shock’ that eventually materialized, as I was faced with an American culture I could no longer relate to, nor easily return to.

I had chosen Hawaii partly because it was the only school of public health in the country that didn’t require the Graduate Records Examination (GRE) for admission, and feared I was not likely to score well after nearly 10 years away from school.

As it turned out, I received an academic scholarship from the State of Hawai’i to finish my MPH degree. And, at the bidding of several of my professors and former development colleagues, I applied to the East West Center, a federally funded research center on the university campus for a scholarship to pursue my doctorate. After all, four more years in Hawai’i sounded pretty nice, with fully funded research that would probably send me back to one of the Asian countries I had been so sorely missing.

530a
View from the Waipi’o Lookout, Big Island, Hawai’i

Actually, I had applied for an East West Center Graduate Degree Fellowship once before — for my Master’s program, but missed it by one place. Out of roughly 600 applicants each year, typically only two are chosen in Public Health – and I came third. But my professors encouraged me to re-apply for a grant to do my doctorate – which I did, and again received a rejection letter. Incredibly, my application had actually been lost and not even considered by the selection committee – and they would not meet again until the following year.

Amazingly, and at the urging of one of my professors, the committee broke protocol and reconvened to review my application – and soon after, I received my acceptance letter and continued on to complete a doctorate in Public Health – fully funded for four years, with research support in Thailand on the topic of abandoned children and HIV/AIDS.

004 (3)
Cycling on Mount Tantalus overlooking Honolulu

On an unbelievable roll – that first year in Hawai’i was like riding a huge wave.  Absolutely loving all the fresh and stimulating activities with barely a spare moment to sit and reflect on it all. Biking to the beach for a swim each morning at 6 AM, to school for breakfast at 8:30, and then back home to collapse at 11 PM.

But all the while, missing my Thai girlfriend Nit more than ever, and still hoping she would be able to come to Hawai’i. But her commitments at home, coupled with time and distance were making that dream harder to hold on to. Nit spoke almost no English and had never traveled overseas, which made the long trip seem even more daunting.

006

Meanwhile, a steady stream of demanding academic responsibilities and social commitments at school filled my days and nights, especially after being elected School of Public Health Class Chair.

A full schedule of fun-filled but exhausting social gatherings included plenty of good food and drink, hiking, biking, swimming and barbecues on the beach — I could barely keep up with it all.

And all the while, feeling the intense impermanence of life – distant friendships, relationships, endless experiences.

But how to hang on to it all?

Stay tuned for ‘Back to School: Alaska (Part One)’, coming soon!

You can read more about Jim’s backstory,  here and here.

 

 

The ‘Expat’ Lifestyle

Author’s Note: In 1989, the Thoed Thai Highland Health Center Project implemented by Tom Dooley Heritage, an American non-governmental organization (NGO), in collaboration with the Royal Thai Government Ministry of Public Health was handed over to Government to assume full responsibility for its continued operations. The five-year Project was a successful international development partnership which provided capacity-building support (funding and training) for its gradual integration into the Thai Rural Health System. 

The experience also set the stage for my eventual entry into graduate school in Hawaii, USA — but not before accepting a one-year position with the Catholic Relief Services, another American NGO, which supported refugee relief work on the Khmer border and community health development in poor, rural communities in Thailand. 

Chiang Rai Province, Thailand

Though extremely difficult to leave, my time as Project Director at Thoed Thai Highland Health Center in northern Thailand had come to an end. The Thai Government was poised to assume full responsibility for operations of the Project, which had developed an appropriate health service delivery model for preventive and clinical health care by training and facilitating the entrance of local health workers into the Thai National Health System.

063
A hill tribe paramedic trained by the Project providing health services at the Highland Health Center

Innovative community-based health and development strategies had been successfully introduced, including gravity-fed village water systems, household gardening, community-based opium detoxification, and vector-borne disease control.

171b
Gravity-fed system bringing water to a remote mountain-top village for the first time.

A multi-ethnic cadre of village health workers trained by the Project had been established and were providing basic primary health care services in their local communities as part of the Thai Rural Health System.

061
Outpatient services at the Highland Health Center

Meanwhile, the District Immigration Officer was certain that I was CIA. After all, the area had been saturated with American CIA agents conducting opium eradication. And although I was not a medical doctor, somehow I happened to be the Director of an American health project in the area. Furthermore, I spoke and understood Thai language reasonably well and probably just looked a little too ‘military.’

In many ways, it was like running a summer camp. Nights lit by serene lamplight, a fun, youthful staff, lively parties, variety shows.  Nine languages were spoken at our health center, representing the various local ethic groups (and three Americans) that comprised our staff. But we used Thai language for general communication and staff meetings.

095 (5)
River crossing at a washed out bridge behind our hospital

Exhilarated and somewhat traumatized by the toughest and most intense work experience yet, I reflected on the many harrowing experiences, such as being pulled across a raging torrent on a swing-like board and cable where a bridge had once stood, before being washed away in the annual flooding due to widespread deforestation in the surrounding hills. Or the night a huge storm ripped through our area tearing the roofs off a dozen houses and knocking down ten others.

All was quiet following the violent storm. But there had been heavy shelling along the border all week long and insurgent fighters belonging to a rival drug warlord had reached the perimeter of our village. Wounded soldiers were arriving at a makeshift clinic across the road run by some of our health staff who were loyal to the local drug war lord, Khun Sa. 

Eighteen of us living at the health center boarded the hospital truck to evacuate down the mountain, but we decided the washed out road — at night and with numerous trees down — would be more dangerous than to chance lying low at the hospital.

015

And of course, each 13 kilometer journey up our treacherously steep and slippery mountain track was an adventure in itself, hanging on for dear life with the rest of the passengers – some of them vomiting – in the back of the violently pitching pickup truck.

018

Riding with my favorite Chinese drug-running driver – we barreled wildly along the heavily rutted road past flooded rice paddies, climbing higher into the mountains that filled the horizon. Meeting other trucks head-on and lifting them out of the ruts to get past, then flying through villages as dusk settled over the hills — with a full moon on the rise — and arriving home in time for a warm beer and a plate of fried peanuts at our only restaurant.

Bangkok

In stark contrast to my 18 months in the mountains (with no electricity or running water), it didn’t take long to settle into the comfortable ‘expat lifestyle’ based in Bangkok with the Catholic Relief Services, an American NGO which supported health and development projects in Thailand and provided comprehensive primary health care services for over 30,000 Khmer refugees living in camps along the Thai-Cambodia border.

357a
Bangkok Traffic

As Office Manager, and later as the Acting Country Representative, I controlled an annual budget of US$ five million, managed 120 employees in five offices nationwide, partnered with Government, NGOs and other international agencies, and ultimately negotiated major revisions to the CRS Country Program strategy to move from a welfare and emergency relief profile towards longer-term, sustainable social and economic development.

381 (3)
With friends on the bridge over the River Kwai

Joining friends from work, weekends in the nearby province Kanchanaburi provided a refreshing break from Bangkok’s notorious traffic snarls and choking air pollution. We stayed in floating bungalows on the River Kwai, and would cool off in the river before heading into town each night for some good food and drink.

386
There’s nothing like a cold beer to take the edge off the heat on a warm, tropical evening 

At home in Bangkok, lazy weekends were spent lounging by the pool feasting on ripe, sweet mangoes with sticky rice and coconut cream.

508 (2)
A thousand bucks per month salary, plus flash accommodation – with a pool! I really thought I had made it!

Life was pretty easy living the high life in Thailand’s cosmopolitan capital city, with a luxury apartment and pool, an air-con office, a lovely girlfriend and a growing circle of friends all sharing the fat and happy expat lifestyle in our version of ‘The Modern Raj.’

024
Relaxing at home with my girlfriend Nittaya

A Chiang Rai Reunion

When I returned to northern Thailand the following year for a visit, the rains had begun. So I kicked off my shoes, donned my swim trunks and made my way barefoot, slipping, sliding and sweating the thirteen kilometers to Thoed Thai Highland Health Center.

049b

The mountain air was fresh and still. I felt absolutely high upon returning to Thailand’s northern frontier — unique and still mostly untouched, with the distant sound of cowbells, a few birds singing, and the full chorus of frogs and insects at night — and a cascade of emotions and memories from those exhilarating times living in the hills.

252 (2)
Reunion with some of the Highland Health Center staff

Breathing in the cool, fresh country air, I enjoyed a swim in our local spring-fed reservoir, hiked to a few nearby hill tribe villages and received a warm welcome from all.

But the wind was shifting and the time had come to set a new course. I would have to leave my friends and give up this extraordinary ‘expat lifestyle’ — after nearly a decade overseas — and return to America to begin my graduate studies in Hawaii, USA.

Stay tuned for more stories, coming soon!

You can read more about Jim’s backstory,  here and here.

Note: An expatriate (or ‘expat’) is a person temporarily or permanently residing in a country other than that of the person’s upbringing. The term is often used in the context of professionals or skilled workers sent abroad by their companies, rather than for most ‘immigrants’ or ‘migrant workers.’