Saigon and Surgery

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(Mai Chau village)

Blogging after Myanmar is a tough act to follow; yet life continues to be interesting in Vietnam. Three days after returning from the Tet holiday, I flew to Ho Chi Minh City for a week-long surveillance conference, which brought together over 80 surveillance officers and technical experts from 19 countries in order to share updates and best practices as they pertain to the conduct and use of HIV/AIDS surveillance data.

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(The rice fields of Mai Chau)

Again, I marveled over the stark contrasts between the HIV epidemic in Africa compared to Asia. Unlike the generalized epidemic in most African nations, Asia has a concentrated epidemic primarily driven by injection drug users (IDU), commercial sex workers (CSW) and men having sex with men (MSM). Therefore, surveillance methodologies delved into the strengths and weaknesses of different approaches to reach these ‘Most-At-Risk Populations’.

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(Mai Chau)

The issues are more complex than one would imagine. How does one enumerate the size of the MSM population? Are there other populations that should be considered ‘most at risk’, i.e., prisoners, mobile populations, etc? How should HIV incidence, or the rate of new infection in a population over time, be estimated? What are the new surveillance priorities in terms of pediatric surveillance, mortality surveillance, case surveillance and using program data for surveillance?

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(Woman making coal bricks)

Answers to these questions and more were discussed in great detail throughout the course of the week. I felt honored to be part of such an impressive group, yet the real beauty stemmed from its diversity. The Asia region includes countries such as Afghanistan, Pakistan, Uzbekistan (and Central Asia), China, India, Papua New Guinea, Malaysia, Cambodia, Laos, and Thailand. Each country brings a wealth of information to the table; their experiences and lessons learned help inform best practices and allows countries to avoid some of the surveillance pitfalls.

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(shucking snails)

After the conference, several of us decided to go on the ‘city tour’ in order to see Saigon/Ho Chi Minh City. The first stop was the Reunification Palace, the home and workplace of the President of South Vietnam during the Vietnam War. This building is most notable for its symbolic role in the fall of Saigon in April 1975, when the North Vietnamese tanks crashed through its gates.

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(Reunification Palace with my friends from Afghanistan)

Next we went to the War Remnants Museum, which primarily contains exhibits relating to the American phase of the Vietnam War. The exhibits ranged from reproducing the ‘tiger cages’ in which the South Vietnamese Government housed political prisoners, to graphically describing torture techniques, to atrocities such as the My Lai massacre (mass murder by the US Army of approximately 500 unarmed civilians, including victims that were sexually abused, beaten, tortured, and even mutilated).

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(Tiger Cages)

Yet the images that still haunt me depict the effects of Agent Orange and other chemical defoliant sprays. From 1962 to 1971, over one hundred million liters of toxic chemicals were sprayed throughout the country, directly affecting approximately 4.8 million Vietnamese, resulting in 400,000 deaths and disabilities, and 500,000 children born with birth defects.

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(Montage of images that were displayed at the Remnants of War Museum)

In fact, we have people in our USAID office working on Agent Orange Remediation Programs. In early 2009, the Government of Vietnam, the U.S. Government, and other donors reached a consensus on a clean-up approach to address dioxin contamination. The approach’s first phase involves removal and containment of dioxin contaminated soil and sediment in secure landfills to eliminate any further human and environmental exposure. The second phase will focus on the longer-term goal of dioxin destruction, which requires more testing before a final remedy can be selected.

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Why haven’t we learned from our past? We’ve created generations of deformities and broken homes, with people still experiencing the effects of Agent Orange today. And now Depleted Uranium is being used in Iraq, Afghanistan, etc., and we have no idea to what extent this radioactive material will wreak havoc on this part of the world for decades to come. As an environmentalist at heart, it worries me that we are so shortsighted as to the true costs of using Depleted Uranium. So many innocent lives are afflicted by war; if only we could redirect those human and financial resources towards alleviating poverty the world would be a much safer place.

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Alas, I’m now back in Hanoi recovering from surgery! One of my back molars became severely abscessed due to a failed root canal/crown. I can honestly say, I have never, in my entire life, experienced such excruciating pain! After a week of intense antibiotics and pain killers, the doctor was finally able to perform the surgery, which included the use of a bone graft (via a cadaver) and membrane from a cow’s Achilles tendon. Needless to say, my jaw is still sore! I’ll return in two weeks to remove the sutures but will need to wait six months to see if the implant/bone graft worked prior to replacing the crown. Ah, the joys of surgery overseas!

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(Buying goods in Mai Chau village)

Finally, one of my dear friends from Malawi is currently in town on TDY! It’s been great catching up with Emily and reminiscing about days gone by. As much as I love my new job, I definitely miss my friends from Lilongwe!

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(Emily and Amy in Hanoi)

Sending much love to all,
Amy

The Many Wonders of Myanmar

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(Young monks at the Hsinbyume Pagoda, Mingun)

After ten glorious days, Myanmar has rapidly become my favorite country in South East Asia! The people are so warm and friendly, the scenery is spectacular, the food is unbelievably delicious, and the place has a low-key vibe that is incredibly inviting!

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(Three-year old monk at Shwedagon Pagoda)

Immediately upon our arrival in Yangon (formerly Rangoon), I was keenly aware of the traffic – so quiet and orderly. Suddenly it dawned on me – where were all the motorbikes?

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(Sunset at Shwedagon Pagoda)

The government has banned scooters within city limits and has made it illegal to honk the horn! I marveled over this bit of information. As inconvenient as the law must be for locals, I reveled in the serenity of the traffic – a far cry from the chaotic street scenes of Hanoi.

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(Little Girl at Shwedagon Pagoda – the unusual makeup worn by both males and females is known as Tha-Nat-Kha powder produced from an aromatic tree bark. It is believed to condition the skin and to protect it from sunburn.)

Myanmar itself is fascinating, with its culture heavily influenced by its neighbors (China on the North-East, Laos on the East, Thailand on the South-East, Bangladesh on the West, and India on the North West) along with Theravada Buddhism. In fact, almost 90% of the population embraces Buddhism, making Myanmar one of the most peaceful, tranquil and safest places in Asia.

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(Golden Stupa of Shwedagon Pagoda)

But the highlight of Yangon is the awe-inspiring Shwedagon Paya, the most sacred of all Buddhist sites. In Rudyard Kipling’s book, Letters from the East, he wrote:

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(Monk Praying)

“To visit Myanmar is to embrace Buddhism. The religion entrenches so deeply into the country’s culture, tradition, mindset that everything I saw, I heard, even the air I breathed, had an unequivocally Buddhist touch. In Yangon, thousands of prayers fill the colossal, Shewdagon Paya days and nights. This splendid golden wonder of architecture that once deeply impressed foreign travelers like Somerset Maugham, is not only the pilgrimage centre for all Myanmar people, but also where the soul of the entire country rests upon.” His words resonated as I walked around this two-and-a-half thousand-year old stupa, 90 meters tall and gilded with gold leaf. And this was just the first day of our journey!

(A series of photos: Woman Smoking Cigars)

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(Woman in Bagan)

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(Woman in Village of Bagan)

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(Another woman in Bagan)

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(Taken along the road to Mandalay)

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(Village outside of Bagan)

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(Market)

The next stop on our itinerary – the Bagan Archaeological Zone! This 26-square mile area contains over 4000 temples from the 11th and 13th centuries, when Bagan was the capital of Myanmar.

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(My travel companions – John, Sarah and Xerxes)

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(The impressive sights of Bagan)

We spent our days exploring various temples, one architectural masterpiece after another, admiring unique Buddha images, intricate mural paintings, and the many craft markets along the way.

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(Sunset at Bagan)

In retrospect, all of the pagodas are beginning to blur together in my mind, yet Bagan remains one of the highlights of this trip. The impressive countryside, with one rural village after another, combined with the rich history of the region filled me with such wonder!

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(Outside one of the pagodas in Bagan)

From Bagan, we drove to the legendary city of Mandalay, whose name alone conjures images of pristine settings. As I admired the scenery out the car window, It seemed appropriate to listen to Robbie Williams’ song, The Road to Mandalay (which is a catchy tune)! I was literally off in my own little dream world as I absorbed the stunning beauty all around. I couldn’t help but smile as we passed old vehicles piled high with baskets and people as well as the many ox-bow carts paving the roads.

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(Delivering goods to the market)

Granted, the lack of infrastructure is an indication of the true poverty of this country. For instance, the distance between Bagan and Mandalay is 180 miles – yet it took almost 9 hours to drive! Not to mention, most of the vehicles on the road are circa 1960 and stripped down to the bare minimum of movable parts.

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(Stopped along the way to see how palm sap is collected and turned into palm sugar)

Myanmar, which has been under military rule in one form or another since 1962, has remained somewhat closed off from the rest of the world. The US has imposed sanctions against Myanmar since 1997. And in 2007, the US announced stricter sanctions against Myanmar, noting:

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(The shores of the Irawaddy River)

“Americans are outraged by the situation in Burma, where a military junta has imposed a 19-year reign of fear. Basic freedoms of speech, assembly and worship are severely restricted. Ethnic minorities are persecuted. Forced child labor, human trafficking and rape are common. The regime is holding more than 1,000 political prisoners, including Aung San Suu Kyi, whose party was elected overwhelmingly by the Burmese people in 1990.”Mrs. Aung San Suu Kyi, a 1991 Nobel laureate, has been under house arrest for most of the past two decades. She remains a powerful symbol for the pro-democracy movement in her nation” (Washington Post, 2007).

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(Playing in front of the drums)

Furthermore, numerous organizations (i.e., Amnesty International and Human Rights Watch) have documented egregious human rights abuses by the military government; and the government has restricted Internet access, blocking Google, Gmail, Yahoo, Hotmail, etc. and most political opposition and pro-democracy pages in order to limit information citizens can access on-line.

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(Sunset at U Bein’s Bridge)

Yet, despite the political neurosis of the government, I had an interesting conversation with a Burmese woman who said that she actually respected and admired their government. After all, “she sleeps soundly at night, knowing that she’s safe (there’s virtually no crime in-country).” Granted, I’m not sure if safety is attributed to the government as much as it is to religion.

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(In the streets of Mandalay)

Mandalay boasts the largest population of monks, with 600,000 living within the village-like area of downtown. As such, we ventured through old teak monasteries and pagodas, one after another, and even stumbled upon a monastery filled with monks studying for exams.

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(Monks studying for exams)

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(Monks playing marbles underneath the teak monastery)

But for me, the highlight was walking along the shores of the Irrawaddy River!

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(Working along Irrawaddy River)

The next day, we hopped on board a boat and worked our way to Mingun in order to see the beautiful white Hsinbyume Pagoda and the Mingun Pahtodawqyi, an enormous brick structure that was left unfinished after an astrologer predicted the King would die should the temple be completed.

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(Hsinbyume Pagoda)

Series of Fishermen along Inle Lake:

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(Sunrise over Inle Lake)

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(Fisherman at Inle Lake)

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(Amazing balancing act – as they row with one leg)

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(Morning catch)

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(Silhouette)

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(Fisherman of Inle Lake)

We then journeyed to Amarapura to see the famous U Bein Bridge – a 200-year old bridge constructed entirely from teak that spans over 2kms in length.

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(Monks riding the ox)

Our final stop was Inle Lake, one of Myanmar’s top attractions. The only way to see the lake is via motorized long-boats. Stilt-house villages and floating gardens are dotted around the lake, with glimpses of leg-rowing fisherman scattered about.

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(The channels of Inle Lake)

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(Boat parking for the market @ Inle Lake)

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(Morning market at Inle Lake)

Another sight to see was the lake’s morning market, which is visited by lake inhabitants and surrounding hill tribes who come to sell and trade their wares. A sea of boats were parked along the shores, as villagers from near and far congregated to buy fish, flowers, food and other necessities.

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(Market at Inle Lake)

One of the surrounding hill tribes are the Paduang, or Long Neck Hill Tribe, originally from Burma (Kayah state) on the Thai border south of Inle Lake. Traditionally, the rings were intended to make Paduang women less attractive to raiding parties from neighboring tribes. The application of heavy brass neck-rings causes deformation of the collar bone and upper ribs, pushing the shoulders away from the head.

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(The Paduang People – or Long-Neck Hill Tribe of Burma)

Today, the traditions are continued in order to provide women from impoverished hill villages with the means to make a living posing for photos. Many souvenir shops on Inle Lake employ Paduang women to lure customers. Granted, instead of posing for photos, they are now running their own craft shop.

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(The Paduang People)

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(Taken at one of the villages at Inle Lake)

Ethically, I was torn while taking their photo. I felt as if I was condoning this culturally induced freak show, yet I felt good about purchasing their crafts. I remember going through this same internal struggle when I first saw the Paduang people in Thailand (Burmese Refugee Camp) so many years ago. At the time, the refugee camp felt like a zoo, with hoards of tourists traveling from afar just to get a glimpse of the ‘giraffe people’. Back then, the women appeared quite sad – as if they were on display for foreigners to snap their image. At least now they’re able to maintain their dignity as they manage their own shop and sell their hand-made textiles.

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(A view of Shwedagon Pagoda taken from the rooftop of my hotel)

Due to the Tet Holiday, all of the return flights to Hanoi were fully booked, requiring two extra days/nights of leave (who am I to argue) :-) As a result, I felt privileged to walk around the streets of Yangon another day…and to relive my old backpacking days in Bangkok along Khao San Road. Unfortunately, I wasn’t nearly as impressed with Thailand this time around…Bangkok was too touristy for me 17 years ago – so you can only imagine what it’s like by today’s standards!

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(Brother and sister in Yangon)

By and large, this entire trip was magnificent! It opened my eyes to a whole other world and brought to light the plight of the Burmese people, their struggles as well as their successes.

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(Breakfast at the market at Inle Lake)

I feel quite fortunate to live in South East Asia! This region is so different from Africa…there’s so much to learn and to experience! I’m already plotting next year’s Tet holiday! I’m thinking about returning to Myanmar and doing some serious trekking to the Northern Hill Tribes. I’ve also been scoping out birding possibilities for my mom and Steve…this could be a birder’s paradise!

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(Fishermen selling their catch at the market)

Sending much love to all,
Amy

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