28 January 2019

[Above photo:  Bago street scene. Women on motorbikes holding umbrellas, sitting side-saddle are just terrifying to me. I’m gripping anything metal until my knuckles are white!]

Instead of taking the ferry to Dalah and exploring the temples and pottery at Twante as I planned last week, yesterday I taxied to the main Yangon train station and caught the 8AM to Bago. Bago, formerly Pegu, was a capitol of Burma.  Feuds, earthquakes, and a shift of the river leaving it without a port diminished its stature; now it is largely a city of reconstructed monuments and ordinary people. When I attempted to buy a round trip ticket at the first window in the station, I was told the train was already full and had already left the station. It was 7:25AM. The man at the window directed me to a second window. When I went there, they shook their heads and sent me back to him. He then asked if I wanted an Upper Class or Lower Class ticket (The division compliments of the occupying Brits, no doubt).  Imagining massive crowds, struggling for a seat, loose animals, and recalling all the photos I’ve seen of Indian trains with people hanging off of them, I opted for Upper Class, 80 cents vs 20 cents for the two hour ride. I gave him 1500 kyat and awaited my 300 in change. “No change right now”, he said. “Wait a bit”. The next lady in line was waiting there for some reason and graciously gave me 300 kyat after 10 minutes, saying she’d collect from him.  300 kyat is 20 cents.

I went to the train. There were two cars with reversed C’s on them, that being the symbol for 1, as in Car Number 1. I boarded the first of them and sat in A-7, thinking, “It’s not very upper class but it’s comfortable, quite clean, and not at all crowded”. I chatted with a teacher from Bago, an interesting and friendly man. At the first stop, lots of passengers got on and someone produced another A-7 ticket, Lower Class. As we tried to figure it out, a conductor arrived and escorted me to the other Car #1. There was my Upper Class seat waiting, faded plush, reclining, with an eating table and a drink holder and a large fan with whose switch I didn’t mess. These are likely 90yo British railway cars, still in service.

The ride was pleasant, as I love train travel. It was pretty noisy, clacking along at 25mph maximum, and every few minutes there would be a large bump in the track and the metal plates at the connection between two cars would clash. The noise was like cymbals being approximated with force next to my ears or several large plate glass windows being shattered. Disconcerting at first but, then, to what we can quickly become accustomed!  We passed the detritus of the city outskirt: ragged, dirty people, tumbledown shacks, fetid canals, ditchbanks covered in plastic and garbage, skinny dogs scavenging. Then it was suddenly country, with square rice paddies a brilliant green, water buffalo working in others, simple but neat little houses, a feeling of rural industry, egrets aplenty, and cooler air.

As we arrived in Bago and I disembarked, a young-appearing man (actually 38yo) asked if I would like a ride around the temples on the back of his motorbike. $8 for 4 ½ hours. “I drive slow.” And, “The monuments are a little far apart.” I thought for 10 seconds and, breaking #1 rule—never ride on a motorbike without a helmet and gear—I said, “Yes.” He did drive slowly, it was a very, very long way between the monuments, and we had no mishaps, even though everyone drives all over the place, on the wrong side of the road, cutting across traffic unpredictably, etc.

He was a sweet guy. Separated from his wife with two kids, 8 and 10, both boys. He sees them a lot, although he lives with his uncle. He dropped out of school in 11^th grade—nervous laughter, “There was a little problem.” Where did he learn so much English? “I don’t know. I never studied it. I just picked it up.” Clearly a bright guy. Isn’t luck of birthright such an indiscriminate, unfair thing?  He’ll be driving that old, underpowered Chinese motorbike or something similar for the duration, I suspect.

After seeing a number of stupas, a massive 125yo boa constrictor creepily eyeing the small children in the room where we all sat next to him/her on the cool tile (no barrier) and watched him/her move about, and a palace or two, reconstructed after one of many terrible earthquakes here, I asked  Zawmoe to take me to a nice place and I’d buy us lunch. Well, I broke Rule # 2 next.  He drove through back streets to a little street food place. It was popular and we had to wait about 15 minutes for a group of fundraisers for a temple to finish up and make table space. We then settled in and, I kid you not, were brought 15 or more dishes—-beef, fish, chicken, pork, all manner of vegetables, tea leaf salad, a soup, a wonderful fermented bean salad, and tea and palm nut sugar for dessert. Oh, and rice, of course. It was incredibly tasty. The total for both of us was $1.93! I haven’t had a moment of illness and it was a great experience.

We visited another temple, 2/3 of whose height I ascended on very steep stairs, a massive reclining Buddha—his pinkie is 10 feet long—, and a little elaborately carved temple with 4 large gilt Buddha statues back to back and hundreds of niches with little Buddha statues all around the walls. In the reclining Buddha temple families were sitting on mats, nibbling, chatting, and a disheartening number of them were, as in America, either together or on their own, engrossed in smart phones.  We returned to the train station where I paid and thanked Zawmoe for his excellent driving and guiding.  Buying my ticket, I struck up a conversation with a young UK pediatrician, Caroline who, with her hospitalist boyfriend Ilim, was working in 4 different hospitals in the delta region, attempting to upgrade the skills of the local GP’s. Touchy business, coming in and telling someone you have a better way for them to do what they have been doing for years, I think.

We chatted a bunch and then I sat in my assigned seat for the return trip, adjacent to the UK Ambassador for a neighboring country and her visiting friend.  The ambassador looked tired and not too cheerful; I’d imagine the job alone could grind you down. Think about having to keep your lip zipped about our current president or, if you were a conservative, through 8 years of Obama. For a lifetime of service. Not a job I’d be eager to take and probably I’d not be able to stay there.

I walked home and was so exhausted from the trip I ate dinner and went to bed at 8:15PM, sleeping undisturbed until 5AM. I awakened to find a photo of Linda’s welcome back to Malawi by the Finches as well a photo shoot of her amazing-looking quarters for the two weeks in Blantyre. I felt strong pangs of longing to be in the mix there. I also awoke to an invitation to speak at a 5 hour CME event at the Yangon Mental Hospital in two days.

The topic is Safety and Quality in Treatment. At first I was bamboozled but quickly wrote an outline in my head about the history of childhood, the United Nations Convention on the Rights of the Child (of which Myanmar was a very early signatory), and issues crossing Public Health, Policy, Child Protection, Psychotherapy, and so forth. I am surprised at how quickly a talk on a large topic I’ve never thought about in its entirety formed in my mind. Actually, it’s a great topic to introduce myself in Myanmar. I even had my tutor teach me this morning how to say, in Myanmar, “I am happy to see you all today. Unfortunately I don’t speak Myanmar well, so I must talk in English.” It should be a hoot.

Now I’m off to have lunch with Clemmie Borgstein, who leaves tomorrow to return to her orangutans in Borneo. We’ll eat at Nourish, next to her yoga studio. The name reminds me of Café Gratitude in LA and Berkeley where, when you order, the dishes are named after humble virtues so you are forced to name them. The waitstaff won’t take your order if you say, “Pita with hummus”.  You must vocalize, “Love’s Open Heart” or whatever the dish is named. Frankly, the food was interesting but the ambience was a pain. It made me feel someone was twisting my arm until I evinced virtue. Say, maybe the House can pass legislation requiring that the current White House occupant must eat take-out once per day from Café Gratitude, served by their waitstaff!

20 January 2019

[Above photo: Preparing for the evening entertainment on Sint O Tan Street, where I live.]

Except for touch, my sensory organs are on high alert. The smells of this town are largely food-related: cooking food, fresh fruits, rotting food, and digested food, with lesser associated fragrances of flowers, bodies, cigarettes, car exhaust. They can come in swift succession, so the mind switches from pleasure and yearning to repugnance in a stride.  Taste is generally controllable. Proprioception is activated by the crowded, uneven, and hole-pocked sidewalks and aggressive drivers, causing me to jump, lean, bend, and switch rapidly from moving forward to quick stops to stepping aside to leaping off or onto the curb. The sun is bright every day and at night the number, positioning, and colors of lights are infinite. Finally, the ever-changing but ever-present sounds. A muezzin calling to prayer, a monk reciting or advising, a megaphone advertising, music blaring on massive speakers—I recall a time when my JBL 15’ whoofer was outsized—, ambulances’ claxons, random car and bus sounds, lots of automobile horns, especially at the end of the day. The roar of portable mosquito abatement machines belching noxious fumes into the drainage canals beneath the sidewalk, the fumes floating up through the sidewalk cracks like sulfurous emissions from the netherworld. The person in the apartment underneath me who, inexplicably, begins hammering on something at 5:30AM an average of one in three mornings. I’m screwing up my courage to visit: knock on the door, point at my watch, and make hammering motions while expressing exasperation on my face.

That much Burmese is beyond my dreams. I can say, “Hello”, “Thank you”. “Excuse me” although the grocery store clerk didn’t get it so maybe my pronunciation is far off, “Do you have any…?” and “Where is the…?” although I cannot yet fill in the nouns so they are not of much use. Anyway, having tea on my deck this morning it seemed much noisier than ever and I wonder if I’ve washed some wax out of my ears or am I in the premonitory stage of a psychotic break. Young schizophrenics, before overtly psychotic, may experience noises as too loud, vehicle speeds as terrifyingly fast, etc. An autistic child in my office once shifted attention rapidly, turning his head. Puzzled, I realized that someone at a distance in the building had flushed a toilet. It does make sense to me, in the case of schizophrenia, that as your focus moves from the external world to the preeminence of your own thoughts, the ability to assess the outside becomes compromised and startling, if not threatening.

As to the language, I’ll start Burmese/Myanmar lessons tomorrow at 10:15AM in my apartment with Pwint Phue Wai. I’ll do it 3x per week as after classes start I’ll be pressed for time and perhaps only do it 1x/week. I’m not intimidated any longer by the fact that, like Vietnamese, Thai, and Chinese, it is a tonal language. I’ve just finished the Ken Burns “Vietnam” series and watching Robert McNamara repeatedly chanting what he thought was “We’ll win” over and over before a crowd when he actually was saying “The little yellow man slips away” or something to that effect should give me pause. The crowd was captured on film laughing. But I’m not at war, I’ll be humble, and people love it when you try their language, even if it is butchered.

The Goethe Institute is a German culture export all over the world. Astrid Kraft was a neighbor and friend in Berkeley who works at the Goethe Institute in San Francisco. The Institute in Yangon is a major hub of culture here, including a wonderful performance space, gallery, and café, housed separately in a colonial mansion and two new, modern buildings, respectively. I attended a piano recital there by a Japanese concert pianist and, more recently, went to an evening of exploring “Dialogue” as a means of conflict resolution. The panelists were Burmese: a leading punk rocker, a documentary filmmaker, a performance artist, a university student in political science, a newspaper editor, and a survivor of 20 years in prison for his role in the 1988 uprising (He has started a new political party. Hard to keep a good man down!). The moderator was a German scholar. We all wore little headphones and if the moderator spoke in English, the headphones produced Burmese. If the panelists spoke in Burmese, the headphones reproduced English. The Burmese were a bit hesitant, the moderator too forceful, and the translator not so good. Pulling headphones on and off was exercise. They never really managed to get a dialogue going themselves, let alone explore the general dimensions of dialogue. However, the evening was saved as I sat next to a friendly couple from Norway, Stein and Eva. He directs the PRIO Peace Institute in Oslo and she is Country Director for RAFT which is an organization promoting peace here. Moreover, I found out online that he researched and wrote a much-lauded book on the beginning of the Vietnam War, the crucial period being in 1946. And I had just completed the Burns’ series. Anyway, Eva has a book group at their home on Monday and he and I shall have a meal at a local French restaurant. And wine and talk.  Company!

Yesterday the parked cars all left my street —Sint O Tan Street—and a firetruck with lots of sweepers moved down my block, hosing and sweeping it.  Then mats were put down covering the entire street for the length of the block. A shrine, complete with a throne, roof, lights, and many huge bouquets of flowers was erected at one end of the street. Orange lanterns were strung over the entire street. At 8PM a monk entered the shrine, sat on the throne, and spoke over a PA system to the many who had assembled, removed their shoes, and sat on the mats facing him. Local entertainment at considerable effort.

This is a very religious society and Yangon is no exception with many Buddhist temples, mosques, Hindu temples, an old synagogue with the founder’s ancient son as the only congregant, Anglican churches, Baptist churches, Methodist churches, Catholic churches, and doubtless more. Some broadcast their music;  many don’t but all will have some. The contrast of the beautiful spire of the Anglican church next to the ultramodern Pan Pacific Hotel (and co-occurring mall, Junction City) juxtaposes the sacred and the profane. Buddhists seems to blend it better; neon and gold all over the hundreds of little temples at the Shwedagon, emphasizing the beauty and value of Lord Buddha.

I am in the final throes of completing my Curriculum for the course. I want to finish it before I begin taking weekends to tour about. But yesterday afternoon I went to a large SE Asian regional art exhibit. It was housed in the Secretariat, the immense and beautiful  government building complex designed by the British and built with forced labor. After the British left, it was used as the seat of the Burmese government. General Bogyoke Aung San, Daw Aung San Su Kyi’s father and the liberator and first president of the new republic was assassinated here. It has been abandoned and closed to the public since the capitol was moved to Naypyitaw in 2005.  It is a magnificent building of grand conception with  40 foot ceilings, beautiful ironwork, and stunning masonry.

The exhibit was 65 installations of conceptual art and less than interesting for me. I find that for me conceptual art often reveals more the idiosyncrasies of the artist than a universal truth, a comprehensible or coherent statement, remarkable skill or technique, or a trigger for my self-reflection. The most enjoyable installation was sitting, sipping tea, and chatting with others as we picked and cleaned mung beans from a huge pile in the middle of the table. It actually was brilliant in its simplicity and so engaging, a little recreation of village life

The sun was slipping down when I left the exhibit so I decided to ride the ferry across the Yangon River to Dalah ($2.65 RT) and back. I always love water doings and water traffic and it was a great way to enjoy the end of daylight.  Every culture has their own shape and style of boat; Burmese rivercraft have long overhangs and slice easily through the water. When travelling in SE Asia on previous trips I have wondered how I could purchase a local watercraft and get it home for use on the Island.  It would be a bit of exotica in Penobscot Bay, for sure. Next weekend I’ll take the ferry to Dalah and rent a motorbike to visit the numerous temples, including one with snakes, and a pottery in nearby Twante.

Tomorrow at midnight I will have been here 4 weeks. All said, it’s going OK although I am tired of suppers alone.

 

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13 January 2019

[Above photo: L to R: Cecily, Eric, Sophie, and Clemmie Borgstein visiting from Yangon, Malawi, Malawi, and Borneo, respectively, on my deck.]

A day of dusting, mopping, several runs for supplies, making salads, getting the table and chairs onto the deck, and coordinating take-out from the local Chinese-Burmese restaurant prepared the way for the arrival of Eric and Sophie Borgstein from Blantyre. Cecily has been working here 5 months and Clemmie came a week ago from an orangutan orphan sanctuary in Borneo where she has been working for a year. The other two Borgstein children, Edward and Bella, are climbing in the Rwenzori Mountains in eastern Uganda (which contain 6 of the 10 highest peaks in Africa). They all bring animation, joy, love, and tales of adventures past and future.

I realize how strange it feels to me to live alone in this city. I have learned that Yangon and environs contain about 10 million people.  I don’t yet have a solid connection to my work.  In addition to my friendship with Sophie and Eric, it is wonderful to share my space with others. I can retreat into a productive solitary life but much prefer a social one.

Cecily led us around town yesterday, through the massive Bogyoke Aung San Market, down passageways and alleys lined with street sellers of handicrafts, gems, food, and clothing. Some of the textiles are very lovely, the rubies are beautiful but leave me cold, and the siren songs of huge sacks of fried grasshoppers fall on deaf ears, though I’ll surely try them once. Crispy-crunchy, salty.  I bid on a painting I’d seen before that I really liked; my offer was accepted and I purchased it for later pickup. We returned to the apartment for a 2-hour rest before the evening meal and subsequent drinks. Sophie napped in their room; Eric and I alternately read and napped in the living room. He, being a surgeon, has learned to sleep anywhere, anytime.

After a lively supper with 4 of Cecily’s female friends, all having come from UK to work here for 6+ months on different projects, we 9 went to the Bar of Double Happiness, one street east of my apartment on Sint O Tan Street. Why Double Happiness? Because mojitos cost 1000 kyats, about 66 cents each so you can easily afford two. Or four. Caipirinha’s also.  But they use grain alcohol instead of cachaca., there is no vestige of a lime, and they seem to have forgotten the sugar.  Pretty strong, grim drinks without any refinement or embellishment. I’ll drink beer there the next time I go.

They are off to brunch with the UK ambassador’s mother-in-law who works in Malawi but is visiting. Then massages. And likely supper, at which I’ll join them. Finally, they all catch the 9PM night bus for Bagan, arriving at 5AM. They’ll tour there, riding electric motor scooters to visit the temples (>3000 are left of an original 10,000). Temples were built by wealthy people to improve their karma so that they might return in a higher life form. The process was to atone for their wickedness. It is convenient to get rich however you can and then use a bit of the proceeds to earn honor and cosmic forgiveness for stepping on so many necks while gathering your fortune. The Borgsteins will all return in 10 days after, no doubt, much fun and many surprises. An intrepid family of travelers.

Dr. Tin Oo drove me to the Yangon Mental Hospital last week. It is a 1500 bed facility stretched over many acres.  We drove for an hour and 45 minutes to arrive. It takes the same to return. Dr. Tin Oo does this 5 days per week, as do most of the other psychiatrists there. In Augusta, Maine, they built the state mental hospital, the second in the US, across the Kennebec River from the front steps of the state capitol building. The legislators must see it every time they walk out of the capitol building, a good way to remind them of their duty to the mentally ill. Not so in Myanmar, where the major mental hospital is so far out of town it is difficult to find.

Lack of skill and staffing shortages restrict patients to largely custodial care plus medication. Still, no one seemed overmedicated and the patients were pretty tranquil. There is no occupational therapy and no attempt at rehabilitation, as is the case in most of the developing world.  I met several eager young psychiatrists who had completed advanced training or degrees in London, Boston, and California and would certainly do much more if given the resources. There is a substantial outpatient methadone maintenance program, as heroin is plentiful and addiction is common.  Methamphetamine is cooked in the border areas and is also an increasingly problematic source of addiction.

I’ve decided not to invest my time in travelling to and from there regularly until my teaching begins in early February. I think it is better spent in preparing my course and settling in so the edges of my life work easily when I am finally busy.

I’ll stroll over to the market now, get a bite of lunch, and then retrieve my painting. I have a good spot for it in the living room. If I feel the patience, I’ll try to fiddle with my new printer to connect it to the wi-fi network so I can scan papers to my computer. I suspect my printer difficulties are that I am somehow not reading the finest of fine prints and not following the directions precisely.  Relationships are flexible but not computers.

And there is that business of increaingly accurate facial recognition software and 200 million cameras surveilling the population of China. And about 500,000 in London. Eric Blair (George Orwell) was prescient, down to the details.

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.

[Above photo: From my deck—Yangon General Hospital in foreground, Shwedagon Pagoda in rear.]

31 December 2018

This year is incompetently, impulsively, and dishonestly growling to a close. Talk about losing youthful idealism. In His case, I don’t think it ever existed. If I’d seen him as a child in my office and with his parents, I’d have felt sympathy for him and his plight but I feel none now.  2019 holds great promise of improvement.

Although I resisted joining Facebook for years, thinking I would be unable to ignore its siren song, I finally became slightly active and joined the Yangon Expat Connection, requesting leads to an apartment. BAM!! 8 or 10 realtors were on it. Impressive. I scheduled 6 realtors and saw 16 apartments in two days. Some were large, soulless marble affairs in peripheral townships. Number 12 is a 9^th floor penthouse, two bedrooms/bathrooms, a deck with plants and outdoor furniture, views of everything, a “Smart” Sony TV the size of a movie screen, new furniture to my specifications, and a nice river breeze. Oh, and free utilities, cable TV and WiFi. I’ve never had cable TV. Plunk in the middle of Chinatown, which is where I want to be. The bustling side streets hold tiny restaurants, fresh meat, flower, and vegetable stalls, etc. There are blocks with nothing for sale but new and rusty tools, piles of used angle grinders and electric drills, and rusty and new bolts. On adjacent blocks are clothing, dishware, and so forth. The price of the apartment is half of the housing stipend Fulbright gives us, so I’ll pocket the balance and use it for taxes. There is almost everything you could want in my neighborhood.

Except true love which is back in Maine, of course. However, I have had companionship in the form of the daughter of good friends of ours in Malawi who has been working here on a project with the British National Health Service helping Family Medicine docs improve their critical thinking. See what you can do if you have a coherent single-payor universal health care system? Global health care teaching and improvement. Anyway, Cecily has shown me around and taken me out to supper with her friends. We ate at an Indian vege place, then moved for great gelato to Sharkey’s, and finally landed in a bar where a loud band played covers of jazz classics, taking great liberties. Dave Brubeck’s Take Five has an unmistakable beginning which the band used before venturing out on their own musical voyage. I doubt Dave will sue for copyright infringement. I had a Japanese Mule, which had sochu, mint, lime juice, and their home-brewed ginger beer, almost healthful.

I can see I’ll spend most evenings alone. The apartment with its views and privacy will be ideal for the same. And if I want something, I can just bop down the stairs and get it. There is no need for a fridge, although I have a new one, except for the left-overs as all food is freshly available. And think of the stair training, going 9 floors several times a day. There is a lift if I want to use it.

Three days ago I walked to the Shwedagon Pagoda and up its many stairs, circling it. I could not recall if one is supposed to walk clockwise or counterclockwise so I watched others.  They were evenly divided so I guessed counterclockwise, which I later discovered is wrong. Even with its construction hairnet, the Shwedagon is magnificently glittery. One Burmese queen donated her weight in gold to be put on the dome.  I can see it from one end of my new apartment deck. It is an estimated 2500 years old.

Two days ago I cruised through 2/5 floors of the National History Museum which is right up the street from my hotel. There were lots of amazing artifacts, including the massive gilded Lion Throne, returned from India to where it had been taken. Think of the lives of royalty, with their silver chin rests, gilded arm rests, lacquerware pillows, and glorious silver betel nut juice spittoons.

There is a prehistoric floor with cases and cases of fossilized teeth and jaws and tusks of animals great and small from the Pleistocene (5 million years ago) and the Eocene (40 million years ago). Stegodon was a massive elephant with tusks to match, dwarfing our current pachyderms; it made me feel pretty insignificant in the Grand Design to see Stegodon’s fossilized molars from 5 million years ago, imagining him chewing up tree branches and leaves.

I rode the train today to sightsee. The circular route takes about 3 hours to traverse the periphery of Yangon, travelling at 15 mph. I could not find the station so looked in my trusty phrase book and the second person I asked actually understood my primitive attempts at Burmese. The ticket cost the equivalent of 12 cents, a bargain for just about anything. But the circular train either hasn’t run for 6 months or won’t run for another 6 months; I couldn’t discern. So I took the train running between downtown Yangon and Pyay, planning to get off at some town and catch the return. After about an hour and many stops and pauses, I exited at Insein (pronounced “insane”) where the feared prison is. I crossed the tracks and got on the train going the other direction, passing the stop near my hotel so I could locate the next one, which will serve my apartment.

Even though it is a national holiday, New Year’s Eve, the outbound train was full. There was a constant flow of vendors working it, carrying and selling bags of lychee fruit, bushels of clementines, baskets of quail eggs, bags of peanuts, sliced green mango with a dab of turmeric or hot sauce, and so forth. I bought clementines and lychee fruit and have been devouring them in my hotel room. The watermelon seller was remarkable, a tiny woman (4’8” on her tip-toes) carrying a little plastic stool and a large tray on which were a broad, very sharp knife and large wedges of watermelon. These she would expertly chop into smaller slices, slip them into a plastic bag, and discard the rind. I watched her halve, quarter, and further slice up an immense watermelon, then stand and put the entire tray on her head and cruise through the train crying out her watermelon pitch. It was impressive. One very enterprising youth had prepacked plastic bags of clementines and with a very deep voice he moved quickly, selling out his entire bushel in only one of the cars. Others with full bushels, but not pre-packed, didn’t sell nearly as many. People really like pre-packed food, unfortunately for the environment.

I’ll again join Cecily and her friends for supper tonight, then probably retire to my new apartment roof to watch the fireworks while the youngsters go clubbing. They are sweet and interesting but there is a generational thing here that I cannot ignore.

I’ll wish at midnight, wherever we are, for Peace on Earth and Good Will Toward Men, Women, Flora, Fauna, and the rest of the Environment of our amazing little sphere.

[Above photo:  A Room With a View. Mine.]

25 December 2018

After a not-so-bad 29 hour flight (3 planes, 3 legs), during which I slept at least 5 or 6 hours (Thanks, melatonin.), I was met by the Head of Psychiatry, Dr. Tin Oo and Dr. Kyi Min Tun, a young psychiatrist on faculty. They were most helpful and welcoming. As we drove to my hotel, Dr. Tin Oo showed me a live stream on his phone of a fire that had just broken out in the large (1500 bed) mental hospital, presumably from faulty wiring in the dining room. After dropping me off at 1AM, they were driving over to witness and help. Is this a bad omen?

My entry here was otherwise undramatic and painless—-no forms to fill out demanding to know if I was bringing in fruit or vegetables, no inspection of my bags, a quick and simple wave through customs. The guidebooks and Fulbright folks are pretty clear that you need 6 months of rent upfront in $100 bills, uncreased, but that you cannot bring in more than $10,000 without declaring it. I don’t want to declare that I am carrying more than $10,000 in US bills on my person in the middle of the night in a foreign-to-me city, so I brought in $9900 plus change. No one even asked me.  Can I learn to be worried when the need arises, not anxious when there is no clear advantage to me for that? What do you think, Linda? It seems part of my fiber, I fear.

I suspect that for most who live in this Buddhist city today is a simply a weekday like any other, excepting that museums and banks are closed.  There is Christmas music in the mall, a tree with lights on it in the  hotel lobby, and the staff are wearing those red hats with white fur and pompons, chirping, “Merry Christmas” to me as I pass; they are feeling it more than I am, I think. It always feels strange to me to see a decorated conifer in a tropical country in December.  If Linda were here, we’d go to Mass, as I’d like to see how it is done here.  The Christmas Mass in Mzuzu, last year, led and directed by Father Richard (who baptized Linda’s first when she gave birth in Malawi in 1980), was a dramatic spectacle to behold. Wild music throughout, complete with ululation and drumming, costume changes, and a living creche with a baptism of a new-born baby boy named, you guessed it, Jesus. Probably 3 hours worth, never a dull moment. None of this nodding-off bringing-in-the-sheep.

I rose late, showered, and had both noodle soup (with chicken, garlic, napa cabbage, hot peppers, etc) and mohinga (fish stew with fried garlic and onions, parsley, fish cake, hot pepper flakes) for breakfast. I topped it off with slices of honeydew and watermelon to lower my temperature to survivable.

The Taw Win Garden Hotel on Pyay Road is well-located for me, equidistant between the Yangon Children’s Hospital and University of Medicine 1.  The hotel appears to be newish and is suspended above 5 floors of shopping mall. I got my phone sorted—-SIM card and calling/data plans—at the phone store, bought a recently-written book on the history of Myanmar, and strolled to the above two worksites in order to orient myself. 20’ gradual walk to each.

Walking on busy Pyay Road I saw elderly couples shuffling along in longyis and sandals, groups of young women with thanaka cream on their cheeks chatting it up, numerous stray dogs appearing of similar parentage, and individuals or small groups moving very gradually on the hot 1PM sidewalks. Once I had discovered University of Medicine 1, I slipped into quiet, shady side streets. They were lined with small sidewalk restaurants, men sleeping on mats on the sidewalk, and one well-dressed man who squatted at the edge of the sidewalk to relieve his bladder. The advantage of a longyi! There were many taxi drivers, either snoozing in their parked cars or tooting to let me know they were available as they drove past. After one or two I stopped waving my hand “No”; they realize that if I don’t respond, I don’t want their services. I passed what must have been a factory or distributing point for “Raspberry Ketone Product 1200mg To Assist Weight Reduction”, as three or four cars advertising the supplement were parked together. Small Pharma.  It was street life not unlike in Blantyre, although the streets are well-paved and it is a much more successful-appearing metropolis. There are many fewer people carrying heavy items on their shoulders.  I passed a cluster of embassies for the republics of China, Egypt, Indonesia, and Malaysia. China had very beautiful gardens; Egypt looked the most down-at-the-heels, consistent with their lower GDP and correspondingly less of a presence in Myanmar. The National History Museum is nearby but had a sign that said, “The Museum Closes Today”, which I assume meant “Closed”. So I returned to my room, having completed a loop.

My hotel room is huge, with a king-sized bed, a massive walk-in shower and a nozzle to match, a couch and writing table, and a balcony with a view over trees, shorter buildings, and busy train tracks. A room with a view of the Shwedagon Pagoda costs $20 more per night.  I figure I’ll just walk to it whenever I want. It must be two kilometers from here.

Cecily Borgstein, the elder daughter of our good friends in Malawi, has been working for an NGO here and has been so friendly and generous of her time. She found me a magnificent penthouse to rent , which was unfortunately a bit too distant for my walk-to-work plan. She left me a darling little spiral zip-up pouch with a wooden ballpoint pen inside as a Christmas gift. And she was willing to get me from the airport and to meet me today for a meal. I am so beat after my flight and sleep/wake dislocation that I plan to meet her tomorrow when I’ll be more fun.

The rest of today I’ll, well, rest. I’ll go to the market downstairs and get some fruit—mangosteens if in season. I’ll settle for mangos or most anything if the former aren’t available. Mangosteens are my favorite of all fruits: sweet and tart, very juicy, easily accessible. They are ubiquitous here when in season but not available in Malawi. The closest thing we had were lychee, which are similar but smaller and less flavorful. Then, later, I’ll get some supper, either in the hotel or at one of the many little restaurants in the mall.

Yangon is 12 ½ hours ahead of Bar Harbor, so it shouldn’t be difficult for Linda and I to keep in touch. My morning is her evening and vice versa. Six or 7 hours difference is much more difficult—excepting weekends, someone is either sleeping or working.

[Above photo: A door on the second floor of the Masonic Building in Belfast, Maine.]

15 December 2018

The year is rushing to a close. Actually, there are just fewer days until the end of the year. I’m rushing about. “Where does this road go?” “It don’t go nowheyah, mistah. It’s stayin’ right theyah.”

I doubt that Bracie, Linda’s cat, notes the approach of the year’s end. She is a salvaged cat who was feral, living off the land in Bracie Cove on Mt. Desert Island, having litter after litter. Did you know that cats kill upwards of a billion birds a year in the US? Anyway, Bracie has been badly traumatized and, living in the wild, at first she was not very sociable. She is infinitely more so now. I’ve always liked cats. My first pet, at 5yo, was a cat. So I naturally wanted Bracie to like me and want to curl up on my lap, as friends’ cats often do to their owner’s surprise. Two plus years ago I picked her up for that purpose and was rewarded with panic and claws. Lesson learned. Now I just stroke her a lot and feed her small amounts of cat food throughout the day. She has no governor on her appetite, having been starved, and will eat until she throws up if given limitless food. She’s getting plump and Linda suggests she substitutes food for love.  The vulnerability necessary to allow love frightens her. Catanalysis. How far have I fallen? Not so different from lots of us, I think. Anyway, she’s a marmalade cat with a wonderfully thick coat. On very cold days I keep thinking of a warm hat and censor the thought.

As the year ends, Boss Tweed is applauding a conservative Texas judge’s ruling (Is there anything worse than a conservative Texan? How about a conservative New Yorker? Or a conservative Kentuckian? Maybe the whole lot of them.) tossing out the Affordable Care Act. Merry Christmas, you with pre-existing conditions. Our Prez? “ It was a big, big victory by a highly respected judge, highly, highly respected in Texas.” And, “We will get great, great health care for our people.” I don’t know about you, but repeating an embellishing adjective doesn’t convince or reassure me. Actually, just the opposite.

On an even drearier note, I’m starting a book by JB MacKinnon, The Once and Future World: Nature As It Was, As It Is, and As It Could Be.  In it he chronicles how we are so adaptable that we ignore changes in the Natural World, unless we live in cities where we don’t see the changes at all, and incrementally we adjust to the new baselines without realizing the degree of our loss. Yes, we recall the tales of bison roaming the plains—-but did we know they were in California and New England as well? And that deer were nearly extinct 300 years ago because their hide—buckskin—was so desirable? A Muskogee brave might have killed 400 deer in a year to sell their meat and skin. The point is that we recall dramatic shifts like the slaughter of the bison or whales to near-extinction but not the gradual but just as consequential loss of so many other species. Anyway, it’s a brilliant book and recalls an Eden of protein development and exchange beyond what we have imagined.

We do inhabit a still-glorious globe with sites and moments of stunning beauty. As we sat in the hot tub last night—-it was 40 degrees out, balmy in comparison with recent evenings—, drank our cider/beer, and watched the half-moon bright enough to cast shadows, it was still and felt pristine, although I’m sure the other animals whose land we inhabit don’t think so.

I’m almost set to go. Taxes, Will, Advanced Directive, Curriculum, Readings, short-sleeved shirts and light-weight khakis ironed, batteries charged, car serviced before I give it to Ari… So many details. The sun is streaming through the window now, but since it is so low in the sky it barely clears the trees and provides little warmth. It is a cold land and Mainers a hardy bunch.

We’ll have a supper-cum-slide show for friends in 2 days. Culling out the best of the best from our two month trip is not easy. I favor leopard over zebra, rhino over springbok, Victoria Falls with double rainbows over the Okavango River. I guess the only way to experience that countryside fully is directly. We don’t want to induce Slide Show Coma, which would be easy to do for someone sitting in a comfy chair in front of a fire after a good meal with wine.

Ariane’s mother generously helped her to buy a house. It is a beauty, on 10 acres, on Deer Isle.  The deal isn’t yet complete but it seems likely. It will be so nice to have her settled nearby; the best part is that she loves it here and is resourceful enough to make it work well for her.

I haven’t mentioned how beautiful the stands of deciduous trees are without their leaves. Will I feel that way about myself in my winter? Will those I love feel that way about me? As we drove through Vermont and New Hampshire, the groves of white birch were just spectacular, rising from the snow like white fur on an immense polar bear’s ruff. Trees are wonderful things, their physiology so amazing, sucking water a hundred feet into the air into their leaves. And their presence—huge sticks in the ground, roots generally hidden, reaching for the sky with their arms.

I favor leaders who have gotten their hands in the soil, not soiled their reputations. It is grounding to work in the ground rather than just pound over the pavement.

[Above photo: A covered bridge, constructed in 1871, in Conway, MA]

11 December 2018

We’ve taken four days and driven a loop to see some of Linda’s relatives, including her beloved 107yo aunt, Pierena. She was Linda’s father’s sister, born in Pittsfield of Italian immigrant parents. Her memory is still sharp, although she’s not walked for the past 2 years, is hard of hearing, and processes  things more slowly than 2 ½ years ago. Back to her in a bit.

We stayed the first night in Littleton, where the grandchildren live with Linda’s daughter and their father. Since I don’t have grandkids of my own bloodline, I so enjoy these: 5yo Amelia and 2 1/2yo James. The many levels of interaction and attachment are fascinating to watch, as Amelia is alternately very sweet and helpful with James and then quite bossy. James, for his part, is less subtle, trying to emulate his sister and then trying to eliminate her. They are so clever. Amelia, starting kindergarten this year, can tell you the first letter of a word after you say it. “Zebra”. “Z”. “George” (a tough one). “G”. Since James is so attentive to Amelia’s accomplishments, he’ll be doing it at 4yo!  It is remarkable to see how Kyle and Rachael pull off good parenting, each working full-time jobs with long commutes.

I so pity the poor 16yo girls, and their babies, who I saw at Seneca Center. Determined to get pregnant so as to have someone to love them, they were naturally met with limitless demands on their time, attention, affection, and ingenuity. And demands which they were so ill-prepared to meet, since their own mothering had been so lacking. Amazingly, some were able to rise to their infant’s needs.

We swung by Conway, MA in the Berkshires to re-visit the site of a very happy childhood memory of mine. When I was five years old, after my mother’s first month-long hospitalization for depression, she and I took the train from Seattle to Washington, DC to see old friends, the Lloyds.  I was so tired at their dinner party for my mother that I put my head in the warm, soft mash potatoes and fell asleep! We then went to Boston and somehow got to Conway in the Berkshires where my grandparents had a small ancient farmhouse in which they lived half the year. There was a tumble-down barn nearby where we kept two horses my mother rented for us.  We rode them daily on the local dirt roads and through the covered bridges. My grandfather, a very kindly and gentle man, let me beat him at casino and canasta repeatedly until I thought I was a genius. It was a lovely, warm time, the softest memory of a childhood filled with more-than-optimal family drama.  The only sour note for me, and I recall thinking it then in some form, was that it seemed unfair that I should be allowed to go and that my brother, Charles, only 2 ½ years older, was not. My mother’s absence had been at least as hard on him.  Linda suggested that in those days the youngest child was often taken to ease the load of the parent staying behind with the rest of the brood.

Next we drove to Pittsfield, at the western edge of Massachusetts, to visit the newly-bereaved widow of Linda’s beloved first cousin, John. Bobbi was lovely and took us in fine detail through John’s descent into Alzheimer’s over an 11 year period. Threats and rages, disappearances, and so forth were contained by her love for him.  It was a sobering but very endearing account, a terrible end to a wonderful, loving relationship.

Then to Linda’s brother’s home in Selkirk, south of Albany. He and his wife have a beautiful old house on 30 acres of Hudson River-front. They were welcoming and fed us well.  I caught up on more of the Orsi family history. Linda and I had talked as we drove about how complex it is to blend already-formed family cultures in old age. Well, I’m old; she’s not. We each attempt to open ourselves to understanding the ebbs and flows of family history, emotions and rituals in order to more fully align with the other.

Richard is a Family Medicine physician, running his own clinic with two nurse practitioners, a lab assistant, etc., working 80 hours/week to maintain his independent operation. He notes that he has been unable to hire a partner, since current Family Medicine graduates all seem to want to be hospitalists, which allows for a more controlled and less demanding lifestyle.

Now we are finishing a visit in Manchester, Vermont. It is a little town 20 miles north of Bennington where Aunt Pierena lives with her daughter and son-in-law. Manchester is nestled up against the Green Mountains and deer, fox, and bear abound. Larry and Janice bought a 244yo house a year ago, big enough to accommodate all their kids’ families for gatherings. It is in pristine shape and spectacularly lovely. It was the Weller Tavern and served for gatherings of locals, beginning in 1774, who pledged  their lives in support of “friends and neighbors”, like Ethan Allen and his Green Mountain Boys, who were being persecuted by the British Crown. Ethan Allen shortly after surprised the British and took Fort Ticonderoga on Lake Champlain, the first victorious sortie in the Revolutionary War.  There are numerous fireplaces with adjacent brandy warmers, 2 foot wide pine floor planks, and a cozy room with built-in benches and an ancient bar. I look at a house like this and, after my initial flush of admiration and appreciation, think “Lots of trim to keep up with.” They love keeping a beautiful home, so it suits them.

Next we’ll arrange to FaceTime with Linda’s sister, Donna, at her ashram in Kerala, S. India, so Pierena and three more Orsi women can chat. Then it’s a 7-8 hour drive to Bar Harbor through the Green Mountains in VT and the White Mountains in NH.

In eleven days I head west to San Francisco, Hong Kong, and, via Dragonair, Yangon. I’m hoping Dragonair is not a close relative of Lion Air, whose plane just crashed into the sea soon after leaving Jakarta, killing all aboard!

I apparently have some apprehension about my next steps.

[Above photo:  All the turkeys in a row.]

Yesterday I split the rest of the maple which we pulled from the woods two years ago. The second maul, which Linda was using last week, is double the weight of the one I was using. Hard getting it over your head but it really cracks through the wood on the downstroke. It’s a musical sound and very satisfying to pop off fireplace-sized chunks.

We made soap two days ago. Well, I watched as Linda made it. NaOH and olive oil/Crisco/coconut oil were carefully measured, mixed into a slurry, and poured into pans to “saponify”. Once solid, they were placed on a table to harden further. Oh, also lavender essential oil for scent. When hard, we’ll cut them into bars with a wire, she says, and wrap them for little gifts in her handmade paper—instead of the customary bottle of red wine at a dinner party, we can bring this. Will our hosts imagine it as a suggestion to bathe?

The noose is tightening. Little did I think I’d feel grateful to Michael Cohen for lying and then telling the truth. What a sea of sewerage DT swims in! Surrounding himself with chiselers and liars. How ever did we sink so deep as a people to elect someone so shallow? Maureen Dowd wrote in the NY Times today about the Clintons’ road show, how they’ve made $240 million from >700 speaking engagements since he left office. What of moment have they to say, at this point? Does it all go into the Clinton Foundation to do good works, I hope? I now feel wary of Hillary, even though she was in most ways the best prepared and most intelligent of our candidates. We all have feet of clay, of course. Since I’ve never had, or made, the opportunity of great wealth or vast public approbation I cannot understand the attraction of spending one’s days mining for money and fame. A miner’s life is, if not dull, repetitive.  Like Mick Jagger at 70+ singing “I can’t get no satisfaction” or “I’m a backdoor man”.  Kind of sad and irrelevant.

There is a must-read article in the Times today, “The Insect Apocalypse is Here”, about the collapse of the insect world. Since they, with their millions of subtly and not so subtly different species and tasks, form the very foundation of our natural processes, it is sobering to note that our degradation of the planet has yielded a 75-90% decrease in many species in a variety of locations. Since everything depends on their toils, it is pretty scary. EO Wilson, in his latest book, talks about how we must allow half of the planet, to revert to a wild state in order to prevent the eventual collapse of Nature as we know it. Of course, if we are gone, life will continue but differently. It makes me hesitate when I drive my car to the grocery or, even more so, knowing that when I’ll fly to Yangon, my personal atmospheric CO2 contribution will literally be tons. Multiply that by an immense number of planes daily and the mind numbs, aware of the implications. And climate-deniers abound, heading corporations and governments, chasing….money? And cod were once so thick in the Atlantic that schooners sailing thorough a school of them would be stopped. One of the author’s points is that we are like the frog in the gradually warming-to-boil pot: we don’t easily recognize the changes.

As I attempt to stave off the frailty, if not feebleness, of ageing—speaking of the frog in the pot—I put unreasonable faith in my daily 20’ morning exercise routine. It, along with regular hikes and walks, keeps me fairly limber and strong. But I can hear the footsteps behind me in the forest, as I race to outrun them. I cannot settle for a non-physical life; it may be forced on me, as it is on so many. I don’t mind moving through life more slowly. I just like to keep doing most of the same.

There is a decidedly morose cast to my mind today. It is reflected in the weather. As we awoke it was snowing vigorously, which I’d love. Now it is 34 degrees and raining. And grey. It is, however, amazing how one’s mental state improves with a fire in the fireplace, a warm onion tart, a glass of red wine, and lively conversation.

We went to a performance of a local choral group last night. It was a beautiful venue, the Saint Sauveur Episcopal Church in Bar Harbor. The guest music director didn’t exactly extract the most from her musicians so the Bach Magnificat was pretty lackluster. She had planned for the chorus and the audience to sing a few carols afterward but, even though the words for the 3^rd and 4th verses were given us and everyone was enjoying it, she stopped us after two verses, saying, “I’d just planned for us to sing two.” I wondered about her parents’ treatment of her. Were they caricatures of rigid Lutherans, as Garrison Keeler affectionately mocks? I like amateur offerings if the performers are engaged with some passion. In two weeks we’ll hear the Bagaduce Chorale which is reputed to be special.  It ain’t New York or San Francisco but I prefer living here.

As I assemble my curriculum for the Child Psychiatry course I’ll teach in Myanmar, I am amazed that I’m taking this on. Teaching an entire 9 month course covering all of Child and Adolescent Psychiatry on my own. Generally there is an entire department of a medical school contributing to it. However, it is an opportunity to effect the course of child treatment in an entire country.  Long on relationship, light on the medication. The power of talking/playing therapy. I’m warming to the task. Plus, weekends I’ll travel about the country, seeing natural and man-made wonders, eating delicious Burmese food. Pretty sweet. No turkey or buche noel for this man on Christmas day: green mango salad and mohinga for me, as I’ll arrive in Yangon at 11:45PM December 24. Perhaps a ripe mango or a handful of mangosteens for desert.

I hope that December is kind to you all. It can be a tough month in a Buddhist sense: more attachments and expectations than can be satisfied.

[Photo above: Bed in the snow.]

I guess Linda’s and my canvasing on election day 2018 paid off! The Blue victories continue to roll in. And His Less-than-Excellency increases his squirming and deceit as his options become more limited and his escape less likely.  Perhaps he can be put to work raking the forest floor in the Sierras after his removal from office.

There are many more serious things, now that the House is retaken, to consider, such as all the dire and believable reports tumbling in concerning the climate changes coming to our globe. And we (mankind) are still building coal-powered electrical generating stations at a rapid clip and mining the black gold at a ferocious pace all over the world.  The anticipated Mars InSight mission, landing on the Red Planet on Monday, may yield important scientific information for us but can anyone possibly think that an escape of 6 billion people to another planet is a solution to fouling our own nest? Or of 6 people?

After publication of Paul Erlich’s The Population Bomb in 1968 there were decades during which fretting about overpopulation was in the public media and consciousness. But we hear little about it now, which further suggests to me that our collective will to remember impending catastrophe is remarkably limited.   If we had intelligent leadership, and leadership by example, I think most people could get behind efforts of self-sacrifice and change in order to preserve our amazing planet for our grandkids. Or for those of someone else.

Speaking of grandkids, we just finished a 4+ day marathon with 10 of us staying in Linda’s home. It is large enough that it didn’t feel crowded. And we devised a cover for the dining room table that makes it 10’x 3 1/3’, comfortably accommodating the 13 people for Thanksgiving supper. Linda, as is her wont, totally knocked herself out with fabulous food and breads and pies and hospitality. The Little Ones, James and Amelia, were darling.  We all hiked around MDI (Mount Desert Island) on two separate days in very cold weather. With 8” or so of snow and record-setting low temperatures (-12C), noses freeze and appetites build. I can see how the Inuit can sit in igloos for months, chewing on blubber, fat having 2x the calories of carbohydrates or protein per gram.

It is 33F and raining now, so the snow will melt. We had the traditional bonfire two nights ago, burning downed trees from the surrounding woods, circling it in warm clothing, drinking hot libations (mulled wine), and commenting on how amazing it was that we could create a successful fire with wet, snow-covered wood and only 1 ½ bottles of charcoal lighter fluid!  As I was spraying it, I recalled how Milton Rosenbaum, the chief of psychiatry at Albert Einstein College of Medicine, squirted some on his barbecue in the 1960’s and the can exploded in his face, burning him badly. I was ready to toss, tuck, and roll if the flame came back up the stream into the container.

I also recalled my elder brother, Roger, holding a match in front of his mouth and spraying a stream of lighter fluid out 6 feet or so to make a flame thrower. This was in a bar and an onlooker, a bit soused, tried it without the proper pressure and his mouth and throat lit up. Lighter fluid burns at a pretty low temperature, so he wasn’t seriously injured. But don’t try it! Roger performed some amazing feats in his youth, like stealing a beer truck and tossing the beer off the end of the town pier. The water was 40’ deep and only he and his friends would know to go there for retrieval on a warm summer night. As his forebrain matured, he became an excellent Navy jet fighter pilot (never saw combat, happily), he got a PhD in physics, married a lovely woman, and had 3 splendid kids. Anyone who knew him misses him a lot, especially his immediate family.

It is a bit strange, joining an already-formed family. Everyone is very nice to me, yet when the memories start flowing I am clearly an outsider. Our guests from the UK, reduced to one couple as the male (Chris) of the other couple was hospitalized in Oxford for weeks on oxygen with cryptogenic organizing pneumonia, were as fun and lovely as can be. They, Penny and Paul, came for an American Thanksgiving and got that plus the Arctic cold wave. They were wonderful sports and seemed to enjoy all the chaos and good cheer. That Chris, a picture of robust, muscular health, should be felled by this is sobering to us.  And by a disorder of which I’ve never heard. He is gradually recovering, hopefully to his former state.

I received permission to apply for a visa, which I’ll do tomorrow. Another strangeness is that it will only be good for 70 days, before which I must re-apply for another.  I sent off 55# of books and teaching videos. And I am beginning to hear of places to rent. I’ll fly out of Boston on 23 December and have a hotel, equidistant from Medical University 1 and Children’s Hospital of Yangon, booked for 10 days.

My next chapter is gradually coalescing. I hope all who read this had a good Thanksgiving.  [And all others, as well, knowing that isn’t likely.]