[Above Photo: A sample mid-day downpour, not smog, at the tail end of the monsoon season.]
8 October 2019
Mangos are gone, passion fruit is in. And durian abides, my luck improving with each gamble. Mangosteen are hanging around but getting more expensive. Supply and demand is a wonderful system and I cannot imagine how leaders of the Soviet Union and China each imagined that centrally-planned food production would work. With a supply-demand system, billions of people adjust and correct daily, an efficient and effective guide for production. I have no training in macroeconomics so the above may be nonsense but it makes sense to me.
The students completed the 3 hour written exam on Friday; they found it difficult, apparently. Everyone stayed for the full 3 hours, except one of the 3 students about whom I’ve worried. But when I graded the exams, she tied for 2nd place! Everyone got a passing mark—60% is passing here. One was in the 90’s and one in the high 60’s but everyone else in the 80’s. Why do I care? I don’t think it correlates well with clinical skills. In part I care because they do.
The oral was yesterday. It was in the University of Medicine 1 main building, the cornerstone of which was laid by Lord So and So (British) in 1919. Huge, lovely in that solid British way, and well-kept, with a central grassy courtyard bordered with flowers. The exam was in a long, wood-paneled room with 30 foot ceilings, all marble underfoot. A compressed U-shaped table stretched the length of the room. We were supposed to sit at the head, at the bottom of the U, with the student at a little table inside the U, facing us. It seemed unnecessarily formidable and threatening so I put us on the side. Khin Maung “Frank” Zaw, a Burmese who has worked as a child psychiatrist in UK for 40 years, and I interviewed. Professor Tin Oo, the department chair, and his predecessor, Professor Win Aung Myint, sat on our flanks and observed throughout the day.
We were served breakfast and lunch by the staff, elegant, complex meals, and tea and biscuits throughout. One would definitely fatten up if examining a lot here.
I was perhaps as stressed as the students, feeling for them as if they were my children and also feeling like it was an evaluation of my teaching, which in part it was. They all passed, although one with less than flying colors. Their anxiety was astounding to me for such bright people. Perhaps I was that way. When I failed my oral Child Boards, I’m sure I was a wreck, too. The next year I retook the oral section and when I sensed I wasn’t impressing them I started quoting Erik Erikson and other Giants and the Young Turks examining me came awake and passed me. There is a lesson in the experience for me but I’m not entirely sure what it is. The only examination I have ever failed. It all seemed arbitrary and expensive. I did visit Detroit to take the re-try, however.
I felt so awful to see my very bright, responsible, and hard-working students in a state of panic induced by me and the process I was leading. Some could hardly speak. Some stuttered. One sort of gave up at the end of the second oral. It was traumatizing for me. But some shone, surprising me, since they often spoke so little in class. They all passed and will participate in the graduation ceremony in 2 weeks. Before that, I will go through both the exams with them in detail, as I want them to know well the parts they didn’t seem to have mastered.
It didn’t help that in my meticulous preparation I thought, “Frank and I will alternate leading, so he’ll do 5 students each of the two session and I’ll do 5.” We still needed 10 copies of the marking sheet each, but I only printed 5 each. No matter, we improvised and had another 10 copied for the afternoon session.
Overall, I feel unfinished, like they should have all gotten 95% on everything or I’ve done a bad job. They all know a lot more about CAP than they did 7 ½ months ago. I suppose it is my sometime severe conscience/ego ideal just doing its thing to me. I tell you, I’ve learned so much about myself doing this.
I was surprised on the last day of clinic at Yangon Children’s Hospital by a delegation of 4 women and 2 men. They were from MSEA, the Myanmar Special Education Association, which trains special ed teachers. Since there are not nearly enough here and I want to be supportive, I embraced their request to speak at their national conference the day I get off the plane returning from Chiang Mai, next Tuesday. I’ll jump a cab to the conference, gobble lunch, hear Madam Vice President give her talk, and then speak for 1 ½ hours about the principles and practice of behavior management. I’ve schooled myself in it to some degree, as my students have needed it and used it to great effect.
For example, a 10yo severely intellectually disabled boy from a village was brought to clinic. He spit on strangers including me, hit other children, broke things in the home when he didn’t get his way, could only say, “Mei mei” (mama), and peed on himself regularly. 5 visits later his vocabulary is up to 6 words, he pees in a pot and empties it himself, he no longer spits, he can play with children and not injure them for the first time, and he enjoys helping his mother with cooking and shopping. She and his uncle, who both love him, are overjoyed and the boy looks very happy, as well. My student, with minimal guidance from me, assisted the family with a behavioral management plan that just fit the bill. I am still incredulous. Oh, he no longer has to be tied up because his isn’t running into the road. What if we’d gotten to him/them 7 years ago when he was seen and put on antipsychotic medication? It’s why I want to support MSEA.
I haven’t planned my trip to Thailand today, other than to purchase a plane ticket and hotel reservations for a few nights. After 3 days of conference I’ll just sniff around for 4 days. I may go on to Chiang Rai, as I’ve heard it is a lovely town. But people at the conference will have ideas and I’ll have some time to scour the internet. Two of my students will go to the conference and one will give a 20’ talk about our program. It seems a very nice conclusion to the teaching, to take two of my students to an international child and adolescent psychiatry conference (ASCAPAP).
I must exercise, shower, and hit the road. I’ll try to jump on the airport bus and save $6, but I’m a little unsure as to how often it passes and if it stops to pick up passengers where I hope it will. Worse comes to worse, I’ll take a taxi, as they are everywhere.
Now in bed in a hotel in Chiang Mai, I did take a taxi as it was hot walking to the bus stop. I had a cappuccino at the airport, met my students, and we had a short flight. Seated next to me was a guy with ear buds in, a baseball cap on, and North Face hiking pants on. I figured him for a late 20’s backpacker doing his SE Asia thing. We started to talk and he was really interesting. He’s worked for 3 years with a Danish NGO—He’s from Long Island.—that helps in refugee camps. They are looking for someone to help direct their efforts on behalf of traumatized children in the camps. How amazing to sit next to him. So he’ll contact me when he is back in Yangon and I’ll meet with his staff to see if we can come up with something useful.
As terrible as some of the world is, some of it is remarkable. However, that statement recalls to me the people saying, “Praise the Lord.” when they were rescued after the New Orleans flood, even though their houses were destroyed and they’d lost a loved one or two. OK, all-powerful enough to rescue you but not your house, your loved ones, the city? Not much sense there to me. Maybe it just was a kind of sigh of relief, like my students are feeling.
A Psychiatrist in Myanmar 