Only A Cold

[Above photo: My Sunday “Metanoia” Interpersonal Therapy training group.]

22 March 2020 [Date sent]

Tuesday: Well, whether it was rhino or corona, I’ve had a virus that has laid me low. This is day 3 of cancelled classes (1 day for one group, 2 days for another). I have been someone who always worked through illness, even when it was a bad idea, both for me and for my patients. I continued my practice through chemotherapy, which wasn’t probably so bright of me; ‘chemobrain’ is a real phenomenon. In this case, what doesn’t kill you (the chemo) doesn’t actually make you (your brain) stronger. I may have had a couple of neurons I could spare so I’ve managed OK since then.

In concert with my CAP students, we have set up Zoom and shall meet tomorrow to determine whether we will move to distance learning at this time. That will be difficult for me, as it definitely will not be as effective, or fun, teaching them over the airwaves. Uh, Net. There are only 5 students and me; the two military psychiatrists were not given permission to continue. It is strange to me because military children often have very difficult lives with frequent moves and authoritarian fathers. I guess those in charge don’t want to open and look behind that door.

Yesterday, Monday, at 11AM my phone rang. “This is Su Su. We are downstairs at your apartment.” Two of my students, with one husband in tow, entered my apartment bearing gifts. Apples, clementines, bananas, bread, a pound cake, and chicken noodle soup, my penicillin. My Professor texted me, concerned. Two of the students in my therapy training group called to see if I needed anything. And, of course, my last group of trainees expressed concern. I keep telling them, I feel 18yo. Forget my chronological antiquity! Actually, after seeing how this cold knocked me over I have some greater motivation to avoid that little be-crowned packet of RNA. Does the fact that it can cause enteritis in pigs reflect badly on the occasional human who gets diarrhea as a symptom? Or are we all just lacking in courage, since it causes respiratory disease in chickens?  I can hear the groans as you attempt to stifle your laughter, this being very sophomoric humor. What do cows do on Saturday night? They go to the moooovies.

Three days ago I laid in a bunch of vegetables, some tiger prawns, and more passion fruit. I’ve blanched most of the veggies and frozen them, as well as freezing the prawns and about 8 bananas that would be going bad before I got around to them. I have enough for a week and the 5 block-long street market is 50 steps from my building so with minimal exposure I can replenish my stock.

Thursday: Yesterday I resumed classes and it was a lot of fun. I have figured out, for me and I think the students, the optimal way to overcome the language barrier. I “lecture” in English with English PowerPoint slides. It really is a guided discussion and they lapse into Myanmar and back into English fluidly. For Journal Club they present in Myanmar but use English PowerPoints so I can follow along. They discuss the article in Myanmar, ask me questions in English, interpret my responses into Myanmar for those who struggle with the language more, back and forth. For Role Plays, of which we shall do many in learning different forms of psychotherapy, I have a “patient” and a “therapist” working in front in Myanmar and one of the more English-fluent students at my ear with a live-stream interpretation. I ring a bell and the action pauses, while we discuss a point or an intervention. They will go back and forth, Myanmar and English, all the while. It makes for a rich experience and they seem to love it.

Today Thi Thi Aye discussed Lenore Terr’s “Wild Child” article, a case study of a once per month therapy lasting 12 years in which she and the adoptive parents rescued a (initially 13 month old) girl who had been raped repeatedly by her Satan-worshipping father, observed her infant sister murdered, been bitten all over severely by her mother and father, observed her grandparents gleefully torturing and killing stray cats and slaughtering sheep in front of her, and more. It is a marvelous paper and Dr. Thi Thi Aye, who has two young children, led an impassioned discussion. She described weeping as she prepared her talk, which, of course, caused me to shed a tear or two. I wrote a note to Lenore,  thanking her for contributing to the education of Child Psychiatrists in Myanmar.

As I reviewed basic counseling skills with the students Thursday afternoon, it became apparent to me that in a busy, one-patient-every-15-minutes, “medication only” practice, open-ended questions are discouraged. You have so little time that you cannot really seek to know, and understand, what is on a patient’s mind. “Yes” is so much quicker than “I have been feeling so confused. Sometimes I want to……At others, I feel like……Etc. ” I wrote about this for the Northern California ROCAP newsletter years ago. Medication practice tends to foreclose on exploration and understanding, viewing patients through the narrow-angle lens of neurochemistry (of which we actually know very little) rather than the wide-angle lens view obtained by asking open-ended questions. Symptoms are to be eradicated, their meaning and etiology discarded in the Bio model of practice. In the PsychoSocial model, they are clues to a deeper understanding of people. What I am awkwardly trying to say is medication practitioners don’t want to know about the whole person. They make more money, and generally avoid the stress of experiencing the discomforts of deeper knowledge and intense feelings, focusing on the prominent symptoms and medication side-effects. If this sounds like criticism, I feel it is deserved. If stand-alone without accompanying psychotherapy, it is poor-quality treatment, even if patients demand it.

WHO currently is worried about Laos and Myanmar and Covid-19 sweeping over them. The medical and public health systems are not robust and it is unclear how transparent the authoritarian governments will be about prevalence of the illness. Sadly, the Metanoia-UNICEF group to whom I am teaching IPT will cease their monastery visits after this coming Saturday because of the virus. I’ll meet with them Sunday and we’ll discuss how to proceed. Since altogether we are only 9—less than 10—I am inclined to keep the Sunday training going. But it may not make sense with no patients; it surely isn’t nearly as good a learning process.

I am brought Myanmar tea—-black tea with lots of milk and sugar and spices—and lemon-ginger effusions by my students, despite my protests that I am feeling fine. Phone calls and WhatsApp shout-outs from last year’s group make me feel well-cared for.

Friday: Change of plans. Level 4 (the highest) travel advisory from the US Embassy telling all of the Fulbrights to head home immediately. If the idea is that we’re going to get smacked, or we already are getting smacked and don’t realize it, hiding outside of Blue Hill, Maine is probably better than hiding in Yangon’s Chinatown, about as dense as populations get.  I have never felt such indecision in myself, likely because both my life and my current identity/project feel on the line and the health risk data is too skimpy to calculate the odds.

I’ve made a reservation to fly home on Tuesday and have notified the appropriate people here. The only airlines flying out of Myanmar go through China, a benefit added to a 30 hour flight. Will I be quarantined in the US when I arrive? I hope Guanzhou can sequester those in transit. Part of me feels I’m being smart, part feels like I’m putting my life on the line to get on a plane for 30 hours, and part feels like I leave with my tail between my legs. I hate the latter feeling but think it would be stupid to stay in order not to feel it.

Sunday: I’ve finished my last direct class, for now, with the Metanoia Interpersonal Therapy training group. I’ll likely finish up teaching the rest of the IPT manual by Zoom. Since their current mental health training project is on hold they have created a new, virtual one that UNICEF is very excited about. These Metanoia folks are courageous and creative! Class was fun, with lunch delivered from Shan Yoe Yar, a great Shan restaurant nearby. After class I returned a call from my Burmese-British colleague who teaches a few hours a week in the CAP program. He had planned to depart for Birmingham, UK where he lives next Thursday but his flights were cancelled. All Emirates and Qatar flights to Myanmar are cancelled for now. He has friends who left Yangon for UK 3 days ago and have been stranded in Dubai since.  His theory is that the recent heat ((98-103F. daily) is preventing the virus from having a free hand here. Perhaps, but it isn’t that hot in the Shan and Chin and Kachin and Karen and Rakhine hills, definitely a lot of population and land area, much of it adjacent to Bangladesh, India, Thailand, and China.

We will eventually know what’s up. For now, my plane is still scheduled to go. Sadly, as my life is very rich here.

Flash alert! Kelly calls and encourages me, if I decide to stay or if all flights are cancelled (Singapore has just closed all its doors.), to move into his large house. His neighborhood is much less densely populated and he has a beautiful garden with trees and quiet, plus Kelly and I can play gin. I confess I like gin, a game so mindless that you actually can win while doing something else. I had a lucky streak once when we were living on the Sacramento River and beat Poki so many times in a row that she refused ever to play with me again. I kind of get it. Ari and I played gin in the afternoons in Yelapa, Mexico. One day we were walking after a swim back to our palapa with two drinks to play and this young housekeeping guy gave me a leering wink. “My daughter”, I said. But I enjoyed it. So, beware, Kelly. You may kick my ass at poker and pool, but at a mindless game, I’m a terror. Oh, does that say something about me?