Settled, 2019

6 January 2019

[Above photo:  After lunch with [retired] senior faculty of University of Medicine 1 Dept. of Mental Health]

Excepting that the sink drain leaks (I have a bucket under it and shall let the maintenance guy enjoy his Sunday, today.) and the light in my bathroom doesn’t go on (In the daylight with the door open I can see well enough to shave.), my domicile is settled. Oh, I need soap dishes and a few similar bits but I have a mop and internet and a cold watermelon and thin quilts for the beds (There are no top sheets to be had in Myanmar, unless I have someone sew me one.) and am very comfy.  I noticed two days ago that I can see the river from my living room. I love my birds-eye perch and if I ever get a pied a terre in NYC or Paris it will have to be a penthouse!

The city, and it is considerable with a population of > 4.5 million, hums beneath me day and night. Friends came over yesterday evening for some bubbly, bringing organic carrots and hummus from the Farmer’s Market (How can you tell a farmer’s market from the open-air food stalls everywhere?) and two packs of cards as a housewarming gift. We sat on the deck as the sky darkened, experiencing the cool river breeze that comes up each morning and evening, as one of them described her life at a chimpanzee rescue program in rural Borneo. The salty snacks simply stimulated our appetites so we dropped down to the street, walked 25 paces left and entered a little restaurant for dim sum and a variety of tasty vegetable dishes. $12 for all 3 of us and we ate a lot.

In preparation for their coming, I did a little shopping for the salty snacks, cheap whiskey (a liter of Crown Royal “Aged in Oak Casks” for 3000kyat or less than $2—David, I’ve won the contest!), a yoga mat, and an electric kettle for tea water.  I was supplied with a bottom-of-the-line electric kettle, all plastic, which heats up really quickly but doesn’t turn off so all the water boils away and it blows the circuit breaker. I could use it, keeping an eye on it like a tea kettle on the stove, but I don’t like the idea of the boiling water leaching out plastic resins into my tea water. As I was cruising the neighborhood on my couch with Google Maps, I realized that I’d walked past an Orange, a local supermarket chain store within a block of my house, many times without seeing it. Must be a mistake, I thought. Nope, a tiny storefront in an old, narrow building opened into a full-service grocery/department store, 5 stories tall. And next door, San Har Gay, another familiar department store, a bit more upscale, with tiny escalators ramping up 4 or 5 stories. I have noticed several times in passing by that as a promo in front of the latter store there is a young man with a megaphone, a large cardboard box filled with new purses and a huge crowd of jostling women—-Filene’s basement. Every so often he shouts something—I imagine, “50% off for the next 2 minutes!”—and the clutch of women becomes frenzied, pushing and elbowing as they grab for the purses. Consumerism at its most entertaining!

To get around, I use Grab, an app like Uber or Lyft. It helps me to know in advance the cost of a trip. Every second vehicle is a taxi here, which isn’t a bad thing if it decreases the need for a personal automobile. Motorbikes are banned from Yangon; some people use e-bikes. I Grabbed a cab to have brunch yesterday with one of the other Fulbrighters in a very fancy mall near where she is staying 25 minutes north of my apartment. She is an interesting woman, a Korean, who has tenure at Seattle Pacific University, a small liberal arts college. Her field is clothing design and here she has 100 students to whom she is teaching principles of entrepreneurship.  She stays in a $22/night hotel near the university and shall do so for 4 months. I’d go nuts in a hotel for more than two weeks. I like to cook and, at this time of life, want space and privacy. I’m already thinking how will I work it if I come back to keep up whatever momentum toward the development of children’s services I facilitate here?  Especially after living in this little palace.  It will sort itself out.  Jaeil had helpful suggestions for me re. positioning myself to have maximal impact here, not the sort of strategic thinking I do automatically.

I had lunch last week with 6 senior faculty, all retired from the University (at 60yo), arranged by the department head, Dr. Tin Oo.  A young psychiatrist, his “Assistant” as she described herself, gathered me from my hotel with her husband, a merchant marine sailor, and drove me to the restaurant. It was a lovely building on a lake and we had a dark, wood-paneled dining room and delicious food to ourselves. Everyone was very friendly. One of the men gave me a history of psychiatry in Myanmar, from the first “Lunacy Act” to the present time. I then explained my thoughts in general about the course. It turns out, and I’d not known this, that they are bringing in academic psychiatrists from all over the country for it. They’ll live here for 9 months and breathe Child and Adolescent Psychiatry so they can return and begin to teach it, starting services in many locales.  I was stunned.

Space for a clinic is at a premium so we plan to start with 3 rooms, each having 3 students. One will be the interviewer, the other two making observations which they shall record and present in order to stay active. Then they’ll rotate for the next patient. Over nine months they should have a decent exposure. One of the faculty suggested that the clinic should run 8AM-5PM 5 days per week with lectures and reading afterwards.  I gasped, imagined the life draining out of me as I managed and supervised all of that, and said, ”I want them to love Child Psychiatry, not hate it.”, carefully leaving questions of my age and stamina out of the discussion.  So we settled on 8AM-1PM 4 days per week for the clinic, an hour lunch break, and 2 hours of lecture afterward for 7 months. It could leave them sleepy for the lectures but what to do?

My concerns about teaching them have to do with cultural ideas about pursuing their curiosity and ana deh. The latter has been described to me as “a reluctance to say anything that might cause another to lose face”.  I’ll be as sensitive as I can but also very direct. I fear they’ll nod that they understand what I am saying but, not wanting to embarrass or challenge me, silently muddle along in confusion.  Of course, no one likes to lose face or feel criticized or not know something we think we should know. That is what being a student is all about, however.  One problem is that they haven’t formally been students for awhile and it may be difficult to slip into that role again. My point will be that we should all be students with each patient we see, enduring the uncomfortable feelings of uncertainty and confusion, as well as the excitement, that come with true learning.

Critical thinking is apparently not taught.  Rather, in keeping with the Asian stereotype, students are taught by rote learning and are very diligent with that. I figure they’ll all be intelligent, since medical school entry is difficult.   I have some time to develop their minds. But adhering to the DSM-5, as necessarily reductionistic as that is, and psychopharmacology imperatives will not serve them, or their patients and families, well. One helpful vehicle I can use is to keep stressing the integration of the Bio[logical]Psycho[logical]Social approach to thinking about each patient.  We all must learn the new microculture of each patient and each family we see. A family system may look familiar to us at first glance but, given the complex critters that we are and how strongly influenced we are by early and ongoing experiences, every family culture is, not surprisingly, different.

I am starting to wear sandals around like everyone else. Footwear all comes off before entering a temple or a house.   Seeing 7 or 8 apartments in a day while wearing my running shoes was a nuisance.  Also, with sandals there are no socks to wash. And your feet feel pretty free in flip-flops, unless you stub your toe on uneven concrete. I bought a new pair the other day, CIORs, manufactured by the Jiakeey Company of Fujian Province, China. “The CIOR is a kind of combinative shoe which is full of medical functions and healthy design. The special functions of it are complete support of your cervical vertebra and strong stability and supports on your body. Furthermore, the high quality arch design and rubber outsole play an important role in anti sliding. We firmly believe that our best selling shoes, the CIOR, can provide you health, comfort and safety.”  How could I not buy them? I’m still struggling with how they are supposed to attach to my neck.