[Above photo: “Logboom Sunday”, a painting by Charles Stewart (my bro) shows a tug pulling a long boom of logs in Puget Sound, the entrance to Seattle.]

12 April 2020

At first it was novelty, acquiring, prepping, and freezing fish, meat, fruit, and vegetables for the coming isolation. Then figuring out how to optimally use Zoom for teaching. Then how to discipline myself, apportioning time between work, leisure, exercise, correspondence, videochats, and on and on. Now I am just getting bored with my own company. Yes, I can do most anything that a person can do alone in an apartment with a full array of electronic devices. Yes, I can contact my friends. But I am missing going out for meals, meeting and seeing and hugging real people. Here I am in Myanmar during Thingyan Holiday (Water Festival, Myanmar New Year, theoretical start of the monsoon season) with no classes to teach for a week and I can go nowhere.

Aillen and I were going to Palawan in the Philippines.  When Macau shut down I thought of going scuba diving in the Meik Archipelago in the far south of Myanmar. Then I planned to go home. Now I am here, curiously whipsawed in place. A patient of mine in Berkeley had a large shepherd-mix who he saw shaking an opossum violently in the back yard of his house and the babies kept flying out of the mother’s pouch. (No one died!) I feel shaken about by myself, I suppose, and for all the movement I remain in the same spot, in my aerie in Chinatown, Yangon.  Discomfort is relative and even though I and my family are not starving, or crazed with worry about my job, I guiltily want to express my dislike of the situation. There, I’ve done it.

I decided earlier in this week to edit my weekly 2 year-long Malwai blog and my 15 month Myanmar blog and see if I can turn them into a good read. Now I have some time to do it. Sublimation is highly overrated as a substitute for sex, but it is fun to revive the memories of those times. Through a false economy, when I switched my WordPress account from Malawi to Myanmar, not wanting to pay for both sites I let Malawi expire. The posts all vanished.  I have all the entries in my computer but I should have just sprung for the few extra $ and kept the Malawi site up. I’ll see how the sorting and editing go. It has potential, I think, but I’ll have to remove my obsessional rants.

Harold and I had a good Zoom chat yesterday.  He and Connie are rusticating in Old Chatham, New York and both are as lively as ever. Imagine when Burma was a British colony, a letter to a friend would leave on a steamboat taking however long and the return would be the same. What if you were writing to a lover? Good lord, the agony! My mother saved all the letters I dutifully wrote her from college; they help me retrieve my past. And remember Air Mail stamps? With “Par Avion” on the blue international fold-up stationary? It certainly seemed exotic and exciting to this kid on Mercer Island when his sister’s letters would arrive from Grenoble where she was working after her freshman year in college. I’m not sure what changed but by my junior year at Harvard my mother refused to let me go to Europe and kick around for a year. Probably a wise step, since drugs were coming in, I was fairly lost and adventuresome, and I likely would have gotten into a situation of some sort. I’m sure she was not wanting to postpone my dependency on her any longer than necessary, as well, although she never complained of it. It is a mark of her character that she never did, despite largely putting me through college and med school. I always had jobs in both, but the bulk of the bills she carried.

The most ominous event of the year, to me, is that the Supreme Court of the United States, by refusing to allow additional days for absentee voting, determined that many Wisconsin voters would have to risk illness (and some, their lives or those of loved ones) to vote in the primary election.   Voter suppression is the key to a Republican victory, as DT and others have openly noted.  Disenfranchisement of minorities has been with us since Blacks were given the vote after the Civil War.  All the bullshit about being “Strict Constitutionalists”, “voter fraud” etc. etc. is like preachers using their religion and excerpts from the Bible to preach hatred. It’s mostly just Big Business, Wealth Preservation, and maintaining the Status Quo.

We all have a right to our values, certainly. But to live by them, not to impose them on others. I’m not saying you must have an abortion if you have an unwanted pregnancy.  Homosexuality is not a life-style choice.  If parents don’t want their children to have school-based sex ed, schools should allow the children to have an alternative activity during that class.  Just don’t complain about the increase in teen pregnancy as a result.  Ignorance is not bliss, as we are bitterly experiencing with our current leadership. Nor is poverty generally a life-style choice or the result of laziness. Much of the world works very hard and is impoverished.

And as to fiscal conservatism, start with Ronald Reagan and move forward, looking at government spending and the national debt. The Republicans, who used to squeal like stuck pigs about “tax and spend” Democrats have run up the most massive debts. Obama, it should be noted, had a high national debt but he inherited two Republican-instigated wars and a massive recession, requiring bail-outs, which came at the end of 8 years of Republican mis-governance. Let’s toss that chestnut in the fire. Clinton, flawed man, left 43 with a $500 billion surplus! What is left that Republicans say they stand for except social values and fiscal conservatism? Fear of non-whites, including immigrants not from Norway? Oh, I’d best stop. My wheels are spinning!

Thankfully my brother Charlie sent the above painting, which calms me and recalls wonderful times hiking and camping, sailing, fishing, canoeing, and kayaking in the Pacific Northwest.  Log booms would be towed past our home on Lake Washington. In the summers we’d sail or row or paddle out to them and run and skip over the loose logs in the middle for hours. Never fell in, never clonked our heads, never drowned. I don’t know if I could have been as casual about it with my children as my mother was with us, even knowing how glad I am she was and recalling what fun we had.  Simpler times. For some of us. 

[Above photo: The Namib desert at Sosussvlei. Relentless in its beauty, like Helen of Troy.]

5 April 2020

I wonder if one way I am dealing with my anxiety about the pandemic is through derealization, a kind of dissociative response. When I see the numbers on CNN or BBC and hear Andrew Cuomo begging for medical help from other states and the federal government, it seems far away and troubling but at a distance. Part of that is from my isolation, 9 stories above street level with views over Yangon in all directions. My contacts with the outside world are: WhatsApp, email, texting, and Zoom, all distanced, once-removed relationships, although I take the garbage to the bin on the corner, 75 steps away, once a week.  When teaching I feel flat, like the late-night comedians who are now operating from their homes. I often enjoy John Oliver or Trevor Noah or Seth Meyers. Stephen Colbert not so much anymore. But without their audiences, their narcissistic requirement for admiration and applause seems more evident and they seem sadder to me because of it. Like some of the air let out of a taut balloon.

Another student and her husband dropped by today, bemasked, to leave 5 bags of groceries. I now have enough toilet paper to serve a village during a cholera epidemic. It’s funny, some of the “staples” are things I’ll never need or use. It is incredibly kind and generous of them to do this for me, unsolicited. I don’t think I express a sense of helplessness, but maybe it is generic here with the male of the species.  Or the generosity with the female.

I know woman can give birth (genius, I am) and are better physiologically in space but I hadn’t realized that their two X chromosomes give them a significant immunological advantage re. infections. And put them at more risk for autoimmune disorders.

I dreamed last night that I was on a beautiful, well-organized farm in Australia, sited in very hilly red-earth country.  On the side of the road was a body swathed in a green tarp or blanket. It was my friend from Seneca, Stuart Brotman, who died at 40yo of a ruptured Berry aneurysm (in the ED of the hospital where his father was the CEO).  Stuart was brilliant, conflicted, full of energy and love, and remarkably intuitive in relationships. He and I, among other exploits, started a wilderness program, taking selected kids from our Oak Grove residential program on backpacking overnight trips. We did two trips in the Point Reyes area and we had a fabulous time. From the first one we learned to select only same-sex kids for each trip. There were no near-babies but there was much less tension for each group. We learned to have a check-list of what to bring. The latter came up while we all ate spaghetti with our hands out of a big pot, Stuart having forgotten the utensils and plates. His genius was to make every experience fun, and it always was. Back to the dream.

Stuart could move his head and left arm a little but all was withered. It was his father’s farm and he loved the outdoors so they’d put him there during the day to observe and breathe the fresh air. I was overjoyed to see him again. Why had there been a funeral for him? Oh, they weren’t sure and wanted to be prepared. As I was talking and listening to him he rolled over the steep edge of the road and fell 75 feet to the slope below. I rushed down to him as an ambulance pulled up. I tried to help but the driver had his procedures and I felt useless. The driver kept dragging his feet, talking on his cell phone, etc. as if Stuart was worthless. I felt frightened and frustrated and angry and all sorts of things.

The stimulus for the dream was my conference call two days ago with Marie, Sarah Wiebe, Karlyn, and Rianna Bensing to Kimally whose 53^rd birthday it was. We recounted stories of Stuart, whom we all loved, and Marie said how she has followed Liz, Stuart’s wife, and Abby, his now 18yo daughter, on Facebook, noting what a great job she felt Liz had done as a widowed mom.

I associated to why Stuart always kept his wife, daughter, and the wealthy side of his family out of our view—I don’t recall every meeting Liz or Abby. I only met his parents at the funeral. He was somehow ashamed of us—or them?   It must have been complicated for Stuart. I have, in my storage locker in Maine, some photos of Stuart that I shall get to Liz at some time, for Abby. The unsettled nature of my longing for Stuart and his sudden death reminds me of my brother’s, Roger (Stewart), sudden death and how I wish he’d survived to see his children’s successes and to be with his wife. Then I circle back to the corona virus and am aware I want to spend time with my daughter, Ariane, and, if ever possible, my son, Nate. I’m not ready for my sudden death, but then no one is.

We had another, expanded, virtual cocktail party Friday night. It now is a regular occurrence. Attending were Kelly, me, Irene, Jose, and Clem. Irene is not interested in poker but the other 4 of us are plotting a virtual poker game. Using Bitcoin? I don’t think the cryptocurrencies have denominations small enough to accommodate us. We’ll likely keep a running tally and pay up when curfew is lifted. The party was lively and both Clem and I laughed so hard we fell over on our respective couches. Admittedly, I drank half a bottle of Chateau Margot du Poissant en Grand Cruz ($11) or whatever and since I don’t drink the rest of the week it goes a long way. Kelly, having watched a couple of documentaries about the meat industry and how superathletes improve performance on plant-based diets, has virtuously undertaken the same during our isolation. Clem talked about the joys of home schooling driving her to risk her life by exiting to her office, leaving the wee ‘uns with their father. Irene had calming, yoga-like advice for us and Jose updated us on his current job-hunt status. He has the job but they won’t quite commit to him because this corona-time is affecting their funding and they may need to restructure.

I feel so for the poor and those watching their businesses collapse and vanish. It isn’t beyond question that one of my banks will fail, DT will use this as an opportunity to exit from Social Security, or my annuity fund may go belly-up. I’ll figure out what to do. I’ll have to get my medical license re-activated, I guess. Imagine, at 80yo. Well, that doesn’t really worry me.

What REALLY worries me is that DT is packing everything and everyone around him—-Senate, Supreme Court, Intelligence Director, Attorney General, Justice Department, etc.—with cronies and toadies so, together with Fox Far-Right Opinion (it is surely not News, as in dispassionate, non-partisan, fact-based journalism), he may lie his way into another 4 years. After which time his dictatorial hold on the country will be even firmer. He is like a perverse Rumplestiltskin, attempting to spin the coronavirus tragedy and his mismanagement of it into electoral gold.

We are too frail of mind, too easily mob-swayed and deceived. Better we were more instinctually-bound. Eat, fight, breed, die. Tooth and beak and claw.  Forget Bach and the Beatles, Tagore and Shakespeare, Nelson Mandela and the Reverend Martin Luther King, Jr. The price of creativity is too high if totalitarianism wins.  But then, we can always find comradeship in the fighting opposition.

 

[Above photo:  Seen hiking up Dedze Mountain in Malawi in January, 2017]

29 March 2020

Monday: I twisted in the wind for two days and three nights after making arrangements on Friday to return to the US, partly in response to Embassy pressure and partly from my own anxiety.  I didn’t feel good about it, at times like a dog running away yipping, its tail between its legs. I had a dream last night:

I was in a hotel lobby and I wanted a copy of the NY Times. An employee waved his arm as a vague direction and I headed off, not really knowing where. I came to a beautiful, old wrought-iron staircase, restored from wreckage and I descended (Associated to University of Medicine 1 and other lovely colonial-era buildings scattered throughout Yangon). Walking to the right I came to a large, bleak parking lot (Associated to Costco and Home Depot in the Bay Area) and a newspaper vendor. I only had a 10,000Kyat note (about $7). I needed change (Associated to my move to the US). He said he’d help me find some so we drove some distance in his car, passing furrowed farmland and a large truck/combine coming towards us. There was also a large and beautiful deciduous tree, fully leaved excepting a perfectly round hole in the side of the canopy. As we drove by I could look in and see an entire world there, with beautiful pebble beaches, streams, and vegetation (Associated to Beach Island). We took a right turn and drove to a farmhouse where the vendor got me change and gave me the paper. I was very disappointed because for my trip seeking change I got only a single, very thin broadsheet with very little information and it was certainly not worth the search.

My associations led me to cancel my flight reservation, whereupon I immediately felt much better. The dream and my associations to it cut through my anxiety and desire to comply with the Embassy and State Department demands. Sometimes I must commit to something fully before I can realize it isn’t what I want.  The trick then is to reverse course.

My students were very pleased that we could continue class and over the course of 4 hours teaching and discussing it I was given: a cup of Myanmar tea, a lunch of spicy chicken with rice, a cup of coffee, and the conviction that we could conduct a psychotherapy case in person and run a virtual child and adolescent telepsychiatry clinic for our clinical experience, at least until the n-corona dust settles here. There are now reliable reports of large numbers of Myanmar laborers returning from Malaysia and Thailand, massing at the border. They’ll fade into the villages and the spread will begin.

After class, two of my previous students met me in the lobby of University of Medicine 1, one with 4 “country eggs” and a box of ImunActiv tablets, the other with a large container of hand sanitizer. The love and generosity of these people won’t stop. Fortuitously, Rector Professor Zaw Wai Soe, who I like a lot, was passing by and greeted us. I told him my plan to raise money (Not exactly now, I think!) for a child psychiatry training center and clinic. All I need is a commitment for the land and a professorship for one of my bright students, I said. He said, “The land is no problem. We can do it.”  He had volunteered the professorship previously. I almost fell down. It all depends on to whom you speak.  And when. And how. Well, there are many important variables.

Tuesday: After our morning class in the now-empty library (the University of Medicine 1 is closed until further notice.), we were eating lunch in the lobby, since the cafeteria is generally jammed with medical students and a perfect site for virus transmission. One of my students brought her rice cooker and heated delicious chicken soup she had made for all of us. Her husband has sent a car from Magwe to get her this evening; there is fear of a lock-down and she has two children at home. She’ll drive from 8PM to 5AM to return home. The head librarian announced that the library was closing until further notice, as soon as we finished lunch. So, we’ll do class via Zoom, which we practiced in the morning in anticipation.

After lunch two of the students drove me to my apartment because they had bought a mountain of food and household supplies for me, thinking, I suppose, that I was a helpless male. They were amazed when I brought my lunch, some chicken in great sauce and broccoli with a dressing. “Ready-made?” “No, I made it.” I sense their males cannot boil water. They certainly take good care of their Professor!

Wednesday:  I went to the “wet market”—read “street market”—this morning and stocked up. A kilo of prawns, a whole chicken, and lots of vegetables and fruit. When I got home I trimmed the veggies and parboiled them, then put them in freezer bags. I peeled the shrimp and put them in freezer bags, as well. There was a mountain of shrimp shells so I boiled them and made a bisque for later use. I simultaneously made a chicken soup in my rice cooker and  roasted the whole chicken on a rotisserie in my fancy Kangaroo toaster oven, admiring it slowly turning and dripping fat.  I had no cotton twine to bind the wings so I cut a piece from an old cotton tee-shirt, which worked fine. All in all, as long as the electricity lasts, I have enough food for a long time.

Thursday: I had my first virtual individual psychotherapy visit. It went well enough, but it certainly lacks a lot in comparison with vis a vis.

The patient is a late ‘teen who did poorly on her National Matriculation Examination and didn’t get into the field she wanted. She is now at a university studying, for her, a lessor subject. She is a bright, petite (95#, 5 feet tall) girl who was accompanied by her aunt. The latter was described by my student, who was with the patient, as 3’6” tall! The girl has always been “number 1” in her class but with that has come bullying and teasing. She has no close friends and never has. She sleeps with her mother; father sleeps in an adjacent bed in the same room. She has never had romantic feelings toward another. She states she feels “empty” and that she enjoys “nothing”. She says these both convincingly and with a certain verve. She sleeps well and is not suicisal, although she cries if she gets a bad grade or after an argument with her mother, who she says brings up her poor performance on the Matriculation Exam when she is angry. “We paid so much for you to do that.” She is cute and makes good eye contact. She notes that even at her age, her parents do not allow her to go outside alone. She states she hasn’t made friends this first year at university. “Everyone is on their phone all the time.” “I have never ridden a bike so I do it whenever I can because there are bikes at school. But everyone teases me about it.” At the end of the hour she smiled and said, “I think this is going to work.” There is an initial positive transference, although we don’t talk about the t-word in Interpersonal Therapy. The trick will be not to scare off the mother; the girl makes me think she is in the grip of a boa constrictor (my fantasy). Clearly, she is very undeveloped socially and emotionally and is heading toward a serious identity crisis, a la Erikson. But she is relatable and motivated.

I decided to demonstrate a course of brief psychotherapy, a la IPT, about which we have been reading and performing role-plays. The students seem eager for this. The difficulty for me is that after 16 visits or so, I imagine the patient will want, and need, more work and therapists aren’t interchangeable so I may be signing up for a long-term case. On the one hand, it will be useful for training and I love doing psychotherapy. On the other, at home I would never, at my age, begin what looks like a long-term case. Still, there is no one else and if I expire or leave before termination, she will have gotten something valuable. And one of the students can continue with her. Now we are struggling with bandwidth for the Zoom.

Friday: I was really lazy today. That is not a compelling first sentence!  I dozed on the couch from 9-11, then roused myself and went for a walk. I can easily avoid being close to people on the street, and many avoid me as I don’t wear a mask. I walked a bit over a mile to a shopping center, Taw Win Garden, adjacent to the hotel of the same name where I stayed for two weeks when I first arrived. On the 3^rd floor is a musical instrument store and I bought a cheap but capable Mieke (Chinese brand) electronic keyboard and a stand. Playing guitar requires steady and regular play or you lose your calluses. Then it hurts and you cannot fret well until they develop again after weeks of steady playing. With a keyboard I can play and not play and all that suffers is my playing, not my fingers. It’ll be fun with my extra free time.

I made some a delicious chicken soup with rice and watched a few episodes of the “Tiger King”, which is all in the news. What a cast of unusual people with unusual tastes and tolerances. The animals are so incredibly beautiful and so unsuited to artificial habitats and human company. They should be avoiding or eating us, not playing with us.

Saturday: Today I fiddled with my Zoom for a surprise birthday call in a week to a friend,  one of a group of us who used to work together. My good friend, Marie, and I—She is considerably my junior but still not a youngster, except with her figure, her mind, and her heart.—figured out how to make it work. Geezer techies!  Marie is a Zydeco dancer of local fame (East Bay) and keeps in great shape while having fun.

I took some garbage to the bin at the end of the block and decided to walk up my 9 floors for the first time. Outside one door were 14 pairs of shoes. Outside another were 11 pairs. And my place is half again as large.  It must be pretty brutal, cooped up like that. We now have 8 confirmed cases of Covid-19 and hundreds of thousands of overseas workers returning from Malaysia and Thailand so we’ll be lousy with virus in a month or less.

There is a fortune awaiting someone who develops a fast-food franchise in the US based on grilled cheese sandwiches. You think, “Yeah, a good one is nice occasionally, but….” I made one yesterday with Dijon mustard. Very good. But today, inspired, I used Indian Mango Pickle Relish. Holy moly! It was sensational! Think then of the various spices and flavorings and types of cheese and bread one could use.  Near-infinite variety plus married to a good soup or a fresh salad, or both, and the franchise rockets upwards. I’m struggling to limit myself to one of these a day. I shall try a different one tomorrow.

So, I’m not suffering at all; just missing the physical presence of my students and my friends.

Last night I had a virtual cocktail party—-I had a glass of beer, they each had a glass of wine—with Irene and Jose. Kelly was to join us but, for reasons unknown to me, didn’t. We talked about all manner of things, including (almost exclusively) variations on a theme by n-corona. It was a nice way to pass 1 1/2 hours, even if I’d rather be in their presence. This will be a regular thing, I think.

In addition to needing competent, decisive, fact-based leadership in a time of crisis, it is apparent how powerfully leadership style can affect the national dialogue. Anthony Fauci is in love with Hillary Clinton and is part of a DEEP STATE cabal to oust Trump?!! Maybe Tony’s face itched, he was concerned by what he was hearing and how he’d have to tactfully undo it, or he had a headache. I’d have had an oculogyric crisis, rolling my eyes as the Great Lump spewed his nonsense. I thought Dr. Fauci has been kind and politic beyond what was required of a distinguished scientific adviser.

[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?

[Above photo: A 13th century temple complex at Sukhothai, Thailand.]

15 March 2020

Kelly and I had supper last night at a little ethnic restaurant, Mu Ai Kachin, in Hledan District. There was no decrease in population density compared with Chinatown; Hledan was packed. There are a large number of street barbeques, especially of delicious-looking fish. Kelly, true to form, brought some Anchor Steam Beer because the place doesn’t sell beer but doesn’t mind if you BYO. We had our usual wide-ranging conversation, including his amazing tales from Malawi where he worked for 5 years in the 1990s. He lived in a former convent on the Shire River in Liwonde. Among other notable achievements, he met and courted his future wife, then doing public health work in the area.

Kelly and a friend designed and built a houseboat, 18’ long with two stories and propelled by a 10hp 4-stroke engine he brought as extra luggage from the US. The pontoons were 55 gallon drums welded together. They would cruise up and down the Shire after work. Wanting more speed, they built a skiff which the outboard would move right along. So rapidly, in fact, that the plentiful hippos didn’t have a chance to rise and signal their presence as they heard the approach of the boat. They were both once flipped out of the boat by a submerged hippo who rose rapidly as the boat passed over him/her. Kelly had the presence of mind to push the tiller to the side so the boat circled back and they popped in quickly, as the large and plentiful crocodiles gathered for a snack. Many fishermen are lost to crocodiles on that part of the Shire, although hippos kill more humans in Africa than crocs, cats, and venomous snakes combined.

My nose was running a bit at supper and my throat was scratchy. In addition, I’d had diarrhea for 3 days which was unusual as I am very careful about food. After returning home at about 9, I headed for bed as I was fatigued. The night was punctuated by an increasingly sore throat, congestion, a fair bit of sweating, and possibly a low-grade fever. At 6:30AM I called off my class for today; I don’t want to infect everyone. I hate to do it as we have momentum and I’d prepared well.

My conclusion is—-inconclusive. These are compatible with the symptoms of early Covid-19 but they also seem like a summer cold, except for the diarrhea (4% of Covid-19 cases have this, puzzlingly.). I’ll rest and shelter in place. Fulbright recently sent out a letter requesting all Fulbrighters to head back to the US ASAP. Since I have only 2 weeks left on my fellowship and since this is now my home, I decided not to comply, letting them know politely. I just cannot duck out of my two classes and feel OK about it. Plus, now I wouldn’t be able to board a plane. And why would I return to the US where Mike Pence and Jared Kushner are in charge of my health and safety? A religious zealot fearful of his sexuality paired with a narcissist whose estimation of his abilities far outstrips them [Witness his ME peace plan.]  As an aside, it’s not surprising that Ivanka married the latter, familiarity here breeding attraction, not contempt. Don’t be fooled by the fact that he is svelte, not portly, like his burger-chomping father-in-law.

I supervise two of the physicians in my Sunday Interpersonal Therapy training group an additional 2 hours every two weeks, since they are the leaders of the group and have each had more training and experience than the others. One mentioned that several of the group members didn’t seem to have been taught basic counseling skills. I thought I should remedy that and realized that I never was taught basic counseling skills. I read books and papers about many aspects of psychotherapy and psychoanalysis, had many seminars examining the metaphysics of angels fitting onto the head of a pin, and had many, many hours of mostly excellent case supervision in the course of my training. As a result, I searched my experience, extracted ideas from various publications, and folded them into a brief training. It’s a start, as all of this is.

One of the boys who they presented to me in supervision was a 14yo from a very rural area. He was sent to the monastery 2 years ago. He never really knew his father, who worked away from home and died shortly after the boy came to the monastery.  His mother remarried and, as seems to be common here (in Malawi, as well), the new husband wanted nothing to do with his new wife’s children so the boy has had no contact with his mother. His older sister died for reasons he doesn’t know 5 years ago. He gets angry easily, teases others, and fights often. He is somewhat withdrawn and chooses to have friends only in school, not in the monastery where he lives and eats. He wants to be a soldier, which would provide both an outlet for his aggression and a ready-made family for life.

The other child presented in supervision is also 14yo from a rural village. After his parents divorced when he was 7yo, his mother left all 4 children and remarried. She has had no contact with any of her children since she left. His father and eldest brother do keep in regular, if infrequent, touch with him. His second eldest brother left home shortly after the mother and hasn’t been heard from since. His sister “disappeared” 3 years ago, at 16yo and her whereabouts is unknown. He seems very intelligent and well-adjusted. He has lots of friends from school and the monastery, has a close friend to whom he can “tell all my feelings.”, and wants to be an engineer.

I don’t know what destroys the family ties in Myanmar. I have seen many children whose parents send them away and never contact them, which is not an economic matter here in the land of ubiquitous cell phones and cheap service.  Maternal-child bonding is instinctual. Is it from grinding poverty? The economic hopelessness of life in rural Myanmar leading to chronic depression? Something in the desirable detachment of Buddhism? What I’ve seen hasn’t involved substance abuse, as we saw so often in broken inner-city families in California.  Clearly the second child’s father, who calls him every 2-3 weeks, and older brother who sees him occasionally, provide him with a feeling of being loved, which contributes to his success in school and close attachments to peers

Every night as I open my bedroom window I look across and down to a floodlit area with several garbage cans. I enjoy watching the rats, often through my binoculars, trundle around in search of food and sex. Freud’s drive theory.  Maybe adventure. Maybe inspiration. They are part of the landscape of every large city, adaptable and ingenious. And prolific. A flattened, desiccated rat corpse was on the sidewalk as I headed to work one day. I planned to see how many days it would remain in the general area; it was gone the next day. A crow? Another rat? A garbage collector, most likely. Yangon appears to function amazingly well, given its size and ancient infrastructure, especially if you overlook the frequent electrical fires. Rats like to eat the insulation off of wires, for some reason. Let’s put some cayenne in it.

My brain is fading as I sneeze more and this thing progresses. Time to stop.

[Above photo: Seated Buddha, unattached and indifferent, among the 13th century ruins of Sukhothai, the ancient capital of Thailand.]

9 March 2020

Today, Monday, is the above-noted holiday, the full moon day of the third month of the Buddhist calendar. There are supposedly many and varied celebrations, although I haven’t been out this morning to see.

The holiday is a blessing, since we are not yet able to have morning clinics,so I must lecture morning and afternoon 4 days per week. It isn’t that much and I have a lot of the material prepared but it gets a bit dry and dull for me and, I suspect, my students without live patients. If my students felt that way I’d have to pry it out of them.  I think the fact that I also am teaching 9-4:30PM on Sundays contributes to my pleasure in having this Monday off.

I am running 10km on my elliptical—it wouldn’t lie, would it?— in less than 40 minutes with the resistance turned up high. Can my calculations be correct? Am I running 6 ½ minute miles? I know I break into a remarkable sweat. Then I do 20-30 minutes of weights and floor exercises. I do feel pretty fit but hate to think of what I’d feel like if I didn’t do it all. These treacherous last few chapters.

Two of my very best friends have just had back surgery. They were at the premier facilities in NY and Boston, so probably in the World. One felt fit as a fiddle in short order and is pain-free and fully functional. The other had a much more complex reconstruction/fusion and has had a very, very difficult post-op course. Both were in my class in medical school. Both have enjoyed active lives—one bikes everywhere, plays tennis, and backpacks/hikes when opportunity avails. The other ran the Boston Marathon 2x plus other exploits. Both are fine, funny, smart, virtuous, hardworking, and responsible people. “C’est la vie”, say the old folks, “It goes to show you never can tell.”

My social life jumped a notch this week with supper out x4 and lots of other interactions (two meetings of private school counselor groups, a lunch, a group of private therapists, etc.). Saturday night I was having an Anchor Steam Beer with Kelly (He can get them at the US Commisary.) when he put on a playlist from Spotify. Suddenly the Beatles were singing “Here Comes the Sun”. This has changed my life! The Beatles were holdouts for Spotify and I couldn’t ever get them; now I can play virtually all of their music. I do it and happy memories flood in of early times in my marriage when Poki and I were friends, footloose and wandering toward our later livelihoods. 2AM trips to Sam Wo in SF Chinatown for Thick Duck Rice Soup (Remember Edsel Ford, the fierce waiter there?) or runs to Point Reyes to sleep in Casa Chiquita where Peter Barnes was writing his first book, Pawns: The Plight of the Citizen Soldier. We had a lot of good, young times. No regrets.

I’ve met such interesting people recently. A young man with a wife, two kids, and his wedding ring a tatoo on his left 4^th finger is directing psychosocial interventions and research in the conflict areas through Johns Hopkins Bloomberg School of Public Health. And has been doing this, here and in Thailand, for >10 years. A contemporary dancer who got involved with refugees in camps on the Thai boarder and has been doing that sort of work since. Her husband is a Burmese who lived in Lowell, Massachusetts for 10 years doing community work among the 300 Myanmar residents in the area; he’s now casting about for similar work here. Others who have spent their lives working in Africa and then SE Asia doing humanitarian work. The amazing Myanmar woman, a physician who organized the UNICEF contract under which I teach on Sundays, spent 3 years in Manila getting a PhD in Psychology, raising her son there on her own. My mother was an adventuress, but she was breaking into then male-dominated professions—medical school, public health, psychoanalysis—, not moving to another country into dire circumstances where your language and cultural reflexes don’t work. Anyway, I am impressed with their vision and courage and perseverance. It’s not like they simply taught a week-long course in a foreign country. It seems worth it just to wear flip flops (outside) or go barefoot (inside) all day. Then there is all the exotica.

INTRUSIVE THOUGHT: I do hope we get a clinic space soon, which statement reflects my frustration at working in a “developing country” with a dysfunctional bureaucracy. It’s not like Child and Adolescent Psychiatry training and service are supernumerary.

I’m handwashing like crazy. Footwashing, too. I shower at least once per day and often twice. It is heating up and will get to 98 today and 103 by next Saturday. I am assured that last year was an aberration in that the rains didn’t start until June. Thingyan, or the Burmese Water Festival, is the second week in April which is when the monsoon usually sets in. Last May, dear reader may recall, the mercury (how quaint!) rose to 105 every day for a month. I pray for rain as I am writing, so I guess I can actually multitask.  Although my hopes that he-who-shall-not-be-named will acquire Covid-19 are of a much higher order. With his wretched diet and aversion to exercise—-except his fingers and tongue—it is amazing he remains vertical. Some justice here, please.

Giggles of the week, seen on the instruction brochure for my new $3.50 travel alarm: “Don’t put clock in the sloppy, dusty, and rusty place.”  I know I am not a fastidious housekeeper, but, jeez…….  Also, “avoid exquisite impact and shake”. Sadly, there isn’t much of that going on here.

 

[Above photo: At Convocation Hall with my splendid former student, Dr. Anawar Yee Nyo, after she received her PhD.]

1 March 2020

This has been a week, teaching from Sunday through Thursday and again this Saturday and Sunday. Tomorrow is a national holiday, Peasants’ Day. Feeling like a serf, I’ll take it.

When I was teaching in Mandalay in January three members of the nursing faculty took me to supper. One, clever and observant, asked, “Do you use a belt to hold up your longyi?” Busted out, I replied, “No. I use a cord. Then I don’t have to worry all day that it will fall down.” “I can tell.”  It stung that it was so obvious I was an imposter. I’ve been open about it, however, with my students and anyone who asks. Well, I went on YouTube and watched two videos and now I no longer use a cord. I tie my longyi like a pro in the morning and it often lasts all day. I still don’t know why it works now and when I tried a year ago it wouldn’t work at all. Another of the Great Mysteries of Myanmar. Like, “Where does the $30 billion from the legal government jade mining go?” Best not to ask too much, I think.

The low point this last week of February was meeting with the Medical Superintendent of Yangon Children’s Hospital with Dr. Le Le Khaing, a very smart and competent woman in my Child and Adolescent Psychiatry 2020 course. I was to meet her outside his office at 9:45AM. At 9:58AM she called me at home where I was sitting in my boxers, unshaven, preparing lectures. Yikes! I whizzed into action, shaved, combed, sun-blocked, longyied up, and hailed a cab in one continuous swift motion. Without my saying so, the cabbie got my anxiety and drove swiftly the couple of miles to the hospital. At 10:14AM I met her and at 10:16AM we were sipping tea with the very genial MS. Oh, the poor nurses are sleeping 6 to a room, I have a new 16 story building going up within 3 years, I am so very appreciative of the work you did last year, etc. But there is no room for a training clinic this year. What about the room we were promised in October? Which room? Who promised it? As I described the room, he said, No, no, that is the resting room for patients who aren’t admitted. No? Well, then it’s the room they use for religious ceremonies? Not being used? Oh, I know, it’s a lecture amphitheater. No chairs? No, you’re mistaken, I’m afraid. I know it. Definitely a busy lecture amphitheater. But I have a meeting with the department heads this very afternoon and I hope we can find you a room. I’ll call Dr. Le Le Khaing after the meeting. Le Le and I said “Thank you. Goodbye.” We headed to the promised room; it was in an unused section of the building, down a locked corridor, and there were bricks and rubble in front of the door. [I’d seen it in October. It was a large empty room not used for years; I’ve been shaping and furnishing it in my mind to be a functional training clinic since I first saw it.] We returned and re-entered his office, sharing our discovery. He became a bit irritated, and re-iterated that it was a busy lecture amphitheater. When Le Le and I were driving away, she suggested that some more powerful (What is less powerful than Child Psychiatry, pray tell?] department had possession of it and was loathe to let us use it lest we put down deep roots. I left very disheartened as the students are ready to start seeing patients. That is where and when they will really begin to learn, not in our lecture hall. She never got that call from him.

I wrote the same to my professor at University of Medicine 1. He asked his protégé, Dr Kyi, to answer me. Dr. Kyi was my student last year and is a great guy, a fantastic fixer, and soothes frayed nerves. “Don’t worry about a room. We’ll arrange for you to meet with the Union Minister (Cabinet minister for Health and Sports) in Nay Pyi Taw soon.” So, we’ll go over the Medical Superintendent’s head, which will surely endear me to him during our future contacts.

This is to alert any of you with a bunch of money. I am meeting with a Harvard/Columbia-trained architect and I’ll be assembling a design for a Child and Adolescent Psychiatry training center/clinic. I will seek to get some land donated by the government. The Rector of University of Medicine 1 volunteered he’s planning to develop a professorship in Child and Adolescent Psychiatry. So I’ll be hitting up friends and family who have some extra for a building fund. Think, you’ll be contributing to the first Child and Adolescent Psychiatry building/clinic/center/training program in Myanmar. If not on a tile or brick, at least your name will be on a brass plaque. Like the carved marble tile on top of the Mt. Popa Monastery which reads: “Burma Superstar San Francisco $20”. That was back when $20 meant something. I’ll be asking for a bit more.

The high point of the week was yesterday. I was up at 6, in the rented van at 7, at the monastery with all the students (8) in my weekend psychotherapy class and other helpers (3) by 9. Three of us spent most of an hour with the head monk, trading pleasantries, eating tasty snacks, and learning a bit about the place. It was founded 20 years ago by two German women and now cares for 120 boys, half of whom are orphans, from all over Myanmar. Many are from conflict zones where there are no functioning schools. The oldest is 17yo, the youngest is 18 months. The food, for they gave us lunch, was delicious.  The kids were sweet and fun and looked well-cared for, if anxious about their exams in two weeks, especially the math and the English. Their stories of loss and abuse were stunning.

My students, four of whom have taken an advanced EMDR course in Thailand, led two EMDR groups in the morning. Then all 8 of them saw a total of 20 cases individually in Interpersonal Psychotherapy, which is where I come in. Since I cannot understand Myanmar, I have to work on the 75% or so of communication that is non-verbal. It gave me enough to talk about with them in class today. Finally, the husband of one of our physicians led the older boys in a soccer workshop while the sister of another of our physicians, an architect, led the younger boys in a drawing class. Moreover, my students are using two standard assessment tools and studying the entire intervention, which will last 3 ½ months, for efficacy. These people are amazing!  On top of that, two of the students, both physicians and leaders of the group, were in a conflict zone in rural, northern Rakhine state all week, training social workers.

If lonely at times, this is such fun, so thrilling, and so worthwhile.

I just hope the drunken 3yo in the White House gets Covid-19 since he brags with such assurance at the amazing job he has done to contain it: some form of karmic justice, please.  How can we complain with Dr. Pence, that renowned public health specialist, at the helm of the containment effort?  He, as governor, in an antiscientific evangelical huff, refused to approve needle exchange for the largest outbreak of HIV in the State of Indiana, despite his public health experts urging him to effect it.  It required two months,while the epidemic raged on, for him to relent and order it, resulting in an estimated 100 unecessary infections. This doesn’t inspire confidence. [God must have said something I missed about needle exchange and Carnal Sin.] His first act as the Covid-19 czar was to make sure that all news about it is filtered by him before its release, clearly for a mellow political spin. Read the wonderful article in the current New Yorker about the dramatic negative effects of news suppression vs. transparency during pandemics throughout history. He probably thinks Covid-19 is a CNN-DNC-inspired temptress designed to put a wedge between him and “Mother”.  If it wasn’t so serious, I’d be crying with laughter.

As unlikely as it is to happen, Tom Friedman’s opinion piece in the NY Times about assembling a winning presidential coalition has great appeal, although the internecine battles have the potential to be legendary.

[Above photo: Ruins at Sukhothai]

21 February 2020

I awoke yesterday morning at about 6AM to an acrid, plastic odor in the air. Thinking the air quality, which has been bad for a week, was seriously deteriorating, I got up and looked out the window to see a massive plume of dark smoke two blocks away. Then sirens from every direction. The lower levels of a 15 story apartment block were burning and there were people trapped in the elevator, as well as on the upper floors. As I prepared my lessons and ate breakfast I kept glancing out the window but the steady stream of dark smoke never turned white, my indicator that the fire crew were getting on top of it. When I walked past it on my way to work, there were blocked streets, dozens of fire trucks, hoses, and water squirting all over.  The large pedestrian overpass at the intersection of Bogyoke and Lamnidaw streets was packed with people watching the spectacle.  Everyone is drawn to tragedy, it seems. I suppose it is our fascination with violence and the relief that it doesn’t impact us directly. As I walked up Lamnidaw yet another truck with a large extension ladder came barreling down the street. I later heard that no one had died and all were rescued from the elevator and upper floors.

Walking home after class, all the windows in the burned and several adjacent apartment buildings were broken out, from street level to the penthouses. It seems these fires are generally from overloaded electrical circuits, so with the hot season approaching and air con use going up we may see more.  It made me realize that none of the apartment buildings have fire escapes. I’d noted it in my previous apartment and thought with some sheets tied together I could get to the adjacent roof. Here it isn’t so easy and I may buy a rope and a pair of gloves to use in an emergency. I can rappel down the side of my building.

The 5 hour bus trip from Chiang Mai to Sukhothai was a bit sad. It is the dry season so there was little green. There were hills but everything had been clear-cut, probably 20 years ago, and there were no old trees. Everything looked about 25’ high and 6-8” in diameter. It looked like lanugo hair on the scalp of someone—me, even—after chemotherapy.  Love those teak decks on yachts and mahogany dining tables in the US, Europe, and China. Malawi is clear-cut, as well, excepting a very few areas which have been preserved as game parks and refuges. I recalled in 1972 when we were in Abidjan that 70% of Ivory Coast’s hardwoods had been “harvested”. Between Chiang Mai and Sukhothai there were the usual roadside stands selling fruit, vegetables, and tourist knick knacks but also larger establishments falling into disrepair, starting with hope and not having lived up to their promise. The scene seemed weary and despairing, clearly my projections.

When I arrived in Mueang Kao [Old Town] Sukhothai, it was hot, crowded and noisy. It didn’t feel like a 13^th century capitol. There were a few dazed tourists, like me, wandering about in the mid-afternoon heat but mainly it was busy with the Thai going about their day.  I had no idea where Sukhothai Indie Resort was, nor did anyone else. None of us could find a tuk-tuk or taxi, which would be incredible elsewhere in Thailand or Myanmar—there’s a job opportunity for an enterprising young business person. However, there were diesel flatbed trucks with canopies and benches, people carriers, plying Route 12 between Old and New Sukhothai. I asked directions of a driver, showing him the address of the resort and the reservation on my phone. He looked puzzled but told me to get on. I did, paid my 30 baht, and watched as he drove to New Town, several kilometers away. The police station was closed so after he hit the end of his line, he looked the “resort” up on the internet and called them for directions. It turned out to be seven kilometers outside of Old Town in the opposite direction. He headed back toward Old Town.  Midway he pulled into his driveway, parked the bus, and we got in his pickup truck. He told me he’d take me to my hotel, which he did.

The “resort” was in the country on the road to Chiang Mai. It sat 100 yards off the highway down a rutted dirt road. 8 tiny cabins next to each other facing a dirt field. “Resort” here meant a place to sleep. No pool, no restaurant, no lawn bowling or croquet, no manicured grounds. It was $14/night so perhaps I was expecting too much.  Nyi, the proprietress, was very nice, however. I was the only person there so was put in cabin #1. It was more basic, albeit clean, than even I expected. There was soap but no shampoo. The shower water, which just sprayed onto the bathroom floor as all do here, wouldn’t exit the drain hole where the floor met the wall, at least not perceptibly, so I was standing in several inches of soapy water by the end of each shower. There wasn’t a window or a fan in the bathroom.

I reminded myself, “Don’t be so hasty booking your hotel next time.  Look up your venue on an area map.” etc. There was a very basic restaurant 150 yards down the highway but as I entered the grounds, three large dogs started barking protectively. A woman came out and shooed them away. I sat under a thatched roof at a picnic table and ordered sautéed chicken with spring vegetables from a picture on the menu. Out came dried fish with spring vegetables. You must roll with it when travelling like this and, I’ll note, I didn’t get ill, which is a minor triumph. And the dried fish were ok. I went to bed early, planning to leave at first light to see the ruins. I would have rented a bicycle from Nyi except the journey is 7 km on a busy 4 lane highway and it gets very hot as the sun advances.

So I arranged to rent a scooter for the next day and Nyi, who lives elsewhere, assured me she’d fill the gas tank in the morning. She did and at daybreak she lent me a helmet and I drove into town. I got comfortable with the scooter quickly, although it seemed much more wobbly than my 750cc BMW, as I rode along the smooth shoulder. I was constantly thinking about the chief of Child Psychiatry at [now] Benioff Children’s Hospital of the East Bay who was riding a scooter around Thailand a number of years ago. He was found lying in a field in coma, the scooter wrecked. After a month in an ICU in Bangkok, he was stable enough to be transferred to a neurorehabilitation unit in the US where he spent the next year trying to learn to walk. I had no close calls and ended up enjoying the scooter. I used it to go between the archeological zones, which were scattered over a 45 square kilometer area.

Late in the day I left a pottery and was heading for supper when the scooter felt strange. I stopped and looked at the rear tire which was flat. Fortunately, hand gestures for pumping up a tire are pretty effective non-verbals and I was directed to a bike shop nearby. After the mechanic filled the tire and it was flat again in 2 blocks. So I pushed it back and he replaced the tube in 10 minutes for $4, including the ride wherever on his scooter to get the new tube. It was impressive. I felt lucky to have found a repair shop so proximate, not thinking about how unlucky I’d been to get a flat in the first place.

Walking all day through the ruins in the various zones I realized how strange it is that we celebrate kings who slaughtered others to grab their land and then enslaved many to build monuments to their magnificence. From the pyramids at Giza and Saqqara to Angkor Wat and Angkor Thom to Bagan to Sukhothai—and, of course, the great castles and cathedrals of Europe—we lionize those who were more successful in their power, terror, and mayhem than their opponents. We are a strange and violent bunch, truly The Planet of the Apes. King Ramakhamhaeng, the most famous of the Sukhothai rulers, is said to have developed Thai script. Likely he had a clever scholar from whom he appropriated the credit for it, since he must have been busy lopping off heads and collecting levies.

It was, however, as Kate had mentioned to me, moving to see the beautiful remains of civilization past in early and late light. Yet as I look out my window over Yangon, this concrete megalopolis, it doesn’t look as lovely as a tree or a lake or a bird. I suppose some of our admiration is for the ingenuity and artistry that is expressed in the monuments.

Many of the ruins had moats, often filled with water. In the moats of the Central Zone I saw the Thai equivalents of snowy egrets, great blue herons, and black-necked stilts. Fish surfaced frequently at dawn and dusk, and there were many large shade trees, so Nature conspired with Man to beautify the area.  Near one of the monuments in the dry Western Zone I watched a hoopoo—I thought they were just in Africa—hopping about on the ground, his or her magnificent crest erect.

I always meet people, young couples or single travelers, when I travel alone. I kept bumping into Sonja Kuhl at different monuments. She is a 30ish German from Frankfurt who is travelling for a year. She started in Canada, where she visited a friend. Because it was so expensive there, she WWOOFed (World Wide Opportunities on Organic Farms) her way across that large country before flying to Central America. She travelled overland through Central and South America before coming to Asia. She now would be in Thailand for 3 weeks before heading to Rishikesh in India to learn to be a yoga instructor. She’s running low on funds but wants to go to Nepal and Tibet before heading home in June. I am always amazed at young women who do this alone. She said she hasn’t had a bad experience and thinks that having short hair may contribute to her lack of harassment. Anyway, it is somewhat reassuring that despite all the drama on TV and in newspapers, an attractive young woman can travel the world alone without incident.  I worry about India, however.

I saw a couple of signs on my trip that were amusing, along the lines of Eats, Shoots, and Leaves: the description of a panda or that of a dissatisfied diner? The first sign I saw was “HELP FOR DOG”, meaning “My dog needs some help.”, or “Work for me and I’ll give you a dog.”  or “I’ll work for you if you will give me a dog.” Then on a tee shirt in the Chiang Mai airport, “LIFE IS BETTER”. Was this a zombie, the walking dead? Or has life now gotten better than it used to be? There is so much room for confusion in words, as is repeatedly evident using social media, whereas making the gestures of pumping up your flat tire is difficult to misinterpret.  “Ugh, Zog wants meat.” There is a good museum in Sukhothai, filled with pottery, jewelry, swords and spears excavated from the ruin sites. I saw a head-shaped stone which the villagers where it was found called “The Head of a Tax Collector”. Like the huge polished black stone sculpture at the base of the Bank of America building in San Francisco commonly known as “Banker’s Heart”.

Which brings us to the end of this installment.  The corruption of DT and cronies is poisoning all our streams. Pardons for his crooked buddies. He must have his masses hypnotized, they care so little about honesty or decency or the rule of law. They are stupid, I’m sorry to say. If only they really knew how bad it could get with an authoritarian leader without a (relatively) equitable legal system. But they seem immune to reason and filled with blind, cringing anger that makes them susceptible to a demagogue. We can, in part, blame ourselves for not seeing to their education and welfare better. But they also have to take responsibility for their well-being because he won’t. As to the ‘pub’s, they are spineless, hopeless. Susan Collins is such a despicable human being. I need this little venomous outlet, even though it shows me in an infantile light.

[Above photo: With my long-time friend, Stephen Arkin, in front of his favorite won ton dive in the Sunset District of San Francisco. 55 years after we first met, I finally realize how much taller he is than I.]

10 February 2020

Although I have a “Multiple Entry Visa” for Myanmar which is good for 6 months, my “Stay Permit” must be renewed after every 70 days. Curious. And the cost is considerable, considering that soon I’ll be working full-time for the government (University of Medicine 1) for free. In fact, it is cheaper to fly to Thailand and back than to pay for a Stay Extension; on your return to Myanmar with a valid multiple entry visa, you get a FREE Stay Permit extension. Since this is my last week before classes start full-time, I am taking 5 days to visit Sukhothai, the ancient capitol of Thailand, replete with wonderful monuments. My friend, Kate, suggested it after a moving visit there herself some years ago. Tonight I’m staying at an old house with four rental rooms (each with a balcony and en suite bathroom) in a very quiet spot in the middle of Chiang Mai. It is run by a lovely, attentive couple and the whole place has an appealing aesthetic, replete with greenery and calm. You go through a small locked gate from the street and walk down a long, narrow corridor lined by bamboo and many healthy plants.  I’ll taxi to the bus station in the morning to catch the 10:15AM for Sukhothai where I’ll stay for a few days.

This evening I wandered through tiny lanes with frangipani trees and bougainvillea in bloom, stumbled on a sweet vegetarian restaurant and made up for not eating lunch. Then I wandered back and, somehow, found the home where I am staying. I’m going to buy a huge vase and bonzai a frangipani tree on my deck. The fragrance is so incredible and the trees look so wonderfully weird.

Aillen was going to meet me here but she was informed that she’d be on a 14 day quarantine when she returned to Macau. Then, more recently, they closed all the casinos and shut down the airport so no flights are going in or out. It would have been much more fun for me travelling with her.

The last week was eventful. I joined Professor Tin Oo at the University of Medicine 1 Library where he and 2 other senior psychiatrists were conducting oral exams for the applicants for my training program. They have completed a written exam already. Happily, there are 5 who will be in the group, not 4 as was proposed, and they are all women. I knew one and met two others who seem terrific. One has left her husband and two children, 5 and 3yo, all of whom she adores, in Magwe and will return each weekend to visit them and run her private clinic. Another will return to Dawei each weekend, a 13 hour bus ride each way, to run her clinic. They work for, and highly value, their education, these docs. And two more psychiatrists, both men, from the Defense Academy have applied and are awaiting Ministry approval. So I may have 7!  Little by little the core of child-trained professionals grows here.

Speaking of which, I began to train the UNICEF-funded group in Interpersonal Psychotherapy for Adolescents on Saturday and Sunday this week. The class ran 9-4:30 each day with a brief break for lunch. There are 7 women and we are looking to add an 8^th participant. One is a psychiatrist, one a GP with a Masters in Psychology, two psychology graduate students, and three others with interest and experience in counselling. They are at very different levels of training, experience, and English proficiency so it will take some flexibility to  bring them all along. The irony is that in this country of great need, it is not easy to find a clinical site in which to do brief (6-12 weeks) therapy. The government programs, including the juvenile detention facilities—euphemistically known as “Training Schools”—all require Ministry approval, which may take forever. The bureaucratic constipation here greatly retards progress.  It’s not as if a better decision is made when a request sits motionless on the corner of your desk for 3 months.

The training group, as with all groups in my experience, was a bit flat the first day, and much better the second. Since I am doing it in my apartment, complete with PowerPoint projector and screen, white board and markers, and a large thermos full of lepay yei jan (green tea), everyone is relaxing a bit faster than normal. Most wore fancy clothing the first day and jeans on Sunday. I shall wear my Shan shorts and a tee shirt, thus avoiding the ironing demanded if wearing a longyi and white shirt.  When lunch came, the leader of the program found a little Shan restaurant a quarter of a block up my street where we can eat for a pittance and the food is fine. I’d walked past it many times but had not peered into the darkness of the entrance to see what it looked like inside. It’s good to have another handy, inexpensive, tasty go-to spot when I don’t feel like cooking. Interestingly, the two young Masters in Psychology students are lively and very engaged, asking questions and revealing themselves openly. I say interestingly because the psychology program at University of Yangon has no psychotherapy training or trainers. They’ll lead the way for the group, I think.

After class Saturday I went to a Burns Night party. The birthday of Rabbie Burns, the de facto poet laureate of Scotland (“Red, Red Rose”, “To A Mouse”, “To A Louse”, etc.), is celebrated wherever there are Scots. We went to two fabulous Burns Nights in Malawi, complete with kilts, sporin, dirks, pipers, highland dancing, and a lot of Scotch whiskey. Plus toasting the haggis and some roasts—of men by a woman and of women by a man. Such drunken fun!

This party was at the home of my friends, Jose and Irene. She is a Scot and loves to sing Scot and Celtic songs, as I described in an earlier post. She has a bell-clear voice, perfect for the job. In addition to singing Scot songs, there was a piper whose drones kept sticking (to the hilarity of all), a young Burmese man who could play truly amazing acoustic and electric guitar, and two women who sing from the American jazz songbook (one is British, one is Dutch). Kelly and I roasted dozens of different kinds of sausages and beer and wine flowed freely. One man, Peter, gave a terrific brief history of the honoree, including his lecherous proclivity. The man delighted in sex, having something like 14 children with at least 4 different women. When he couldn’t sleep with the woman he was courting, he’d sleep with her chamber maid. Given that there was no birth control, excepting abstinence, 14 may not actually be as astounding an indicator of his libidinal appetite as it would seem today.  Perhaps it says more about his lack of responsibility.

I had to leave at 10:30PM, since I was tired from teaching all day and had to do the same the next morning. I wrote a brief thank you to my hosts when I got home and sent it off on WhatsApp, going to their many invitees. In it I mentioned I was sorry I had to “fuck out early”. Now, if you look at a qwerty keyboard, f and d are immediate neighbors, especially on a bitty iPhone. When I discovered it in the morning the two responses were, “A typo, I think.” And “Homage to Burns, I’m sure.” Good laughs were had.

And good laughs were needed this week, given the disgusting mess the Pres. and his cronies are making of our government and country. If the GOP weren’t so spineless, they could contain him quite easily, even without removing him from office. They certainly managed to thwart the majority of Barack’s good deeds, and he is intelligent (like a human, not like a reptile). We must get out the vote and then he’ll go.

[Above photo: From my balcony the Year of the Rat celebrations on Sint Oh Tan Lan, Yangon. Notice the yellow dragon. A perfect petri dish for 2019-nCoV!]

2 February 2020

It is so pleasant to awaken whenever, lie there for as long as I like in a dreamy state, and then arise as my mind organizes itself to head in a particular direction. However, starting next Sunday I’ll have a class here from 9-5 every Sunday, excepting two in April (Thingyan Water Festival Holiday), until the end of May. In my eagerness to combat loneliness, spread the word, and to work with UNICEF I signed up to train 8 in psychotherapy on Sundays. Happily, I anticipate it will be a fun and lively training and it is something I feel very comfortable doing.  The 4 people I know who have already signed up for it are terrific.

I’m putting together a presentation for the annual meeting of the American Academy of Child and Adolescent Psychiatry which happens to be in San Francisco in October 2020. It is fun to think about last year’s course and how to make this year’s better. And I’ll get to see my friends in the Bay Area, as well.

The 3 day training of 33 faculty at the University of Nursing Mandalay went well. The nurses are so appreciative of a physician who treats them as an equal.   Doctor-nurse relationships have paralleled man-woman relationships for too long. Different but complimentary skill sets doesn’t mean superior-inferior but it has gotten expressed that way. I recall in Malawi asking one of my Peace Corps cohort, a distinguished researcher/clinician, why he didn’t include the nursing staff on medical rounds each morning. It hadn’t occurred to him, although the nurses had much more information about the condition of the patients and the patients’ families than did the doctors or medical students he was teaching.

Some of the younger nursing faculty were really on the money, understanding what I was saying and asking interesting questions. Some were pretty quiet and some seemed to not understand it very well. Of course, only a handful were Mental Health faculty. But they all were very appreciative and want me back with more in the Fall. The Head of the University of Nursing, Professor Nyi Nyi Htay, was a smart, engaging guy with a PhD and strong research interests. The whole enterprise is underfunded, of course, and it is a life-long dream for them to go to a single conference abroad. The entire health care establishment feels like an engine whose fuel supply is so restricted it cannot develop more than 20% of its potential torque.

Along those lines, there are a lot of Masters and PhD theses lining the shelves of the libraries. They cannot afford the fees to have them published in open-source journals (like PLOS) and no one can afford the subscription fees to the other journals (Lancet, BMJ, JAACAP, JAMA, etc.). Lots of careful thinking and hard work may get them a degree but their contribution to the corpus of knowledge is orphaned, gathering dust. I spoke with Harold about how I might set up an on-line repository, since PLOS was his baby, and he had some good ideas.

[Jesus! I just got a Skype call from a pretty woman with a lot of cleavage called “Nice Priscilla”. Freaky. Time to run a thorough scan of my computer, I think.]

I’ll talk with the Powers-That-Be about developing a simple system to scan and put online all of the research that is moldering away. It must make the students feel dispirited about their work, knowing it isn’t going to be shared.

In Mandalay I stayed at the Royal Naung Yoe Hotel; it was a modest place but clean and quiet with an extensive breakfast spread. Curiously, on different booking sites the price of a room varied from $15-55/night. My room was tiny, much like being on a sailboat; everything needed was there but in a very restricted space. The shower, like most here, had an immense shiny nozzle and plenty of warm water; it ran onto the tiled, tilted floor and out the other end into a hole in the wall. I think it must have been into a pipe and the joint wasn’t cosmetically complete. Still, I imagined rats and kept the bathroom door shut. My sleep was disturbed by the episodic and frantic howling of groups of street dogs nearby.

I had forgotten it was winter with cool evenings in Mandalay and didn’t bring a sweater or fleece. From the minute I arrived at the airport in Yangon I began to freeze. On the plane surrounded by people sneezing and snuffling, with visions of corona virus in my head, I continued to shiver. So when my hotel room was warm, if a bit stuffy, I was happy. The last night, however, I wanted fresh air and opened the window; within a minute a mosquito was buzzing in my ear. I slapped her (only the females bite us) hard and arose with resignation for the presumably futile exercise of trying to find, and kill, a tiny insect in a room with shadows, drapes, furniture, and a 12 foot ceiling. Wonder of wonders, on my pillow was a dark creature; indeed, the same mosquito who had tortured me. Back to sleep.

My students from last year’s course took me to supper and we laughed a lot. They are so thoughtful; I shall stay a few extra days on my next trip so I can see them and their workplaces. They have started a Child Psychiatry Clinic at Mandalay Children’s Hospital! I am so proud of them.

The senior faculty of nursing were kind and generous, arranging for my transportation each day and taking me to a splendid supper on the last night. There were formal opening and closing ceremonies for the course, officiated by two junior faculty members, with the giving of certificates of attendance, photos, speeches, and gifts.  They don’t have many extra-mural trainers and they seemed very pleased, as was I.

I returned to Yangon the next day, fatigued.  However, when Kelly and Jose asked me to join them at Byblos for pizza and pool, I couldn’t refuse. We had laughs, as my pool was awful.  I’m not sure what has happened; I used to be pretty good (50 years ago).  My vision is wanting and my eye hand coordination seems less than ideal now. Am I ageing?

I noticed I am not walking distance regularly and am feeling out of shape. So I purchased a magnetic  elliptical cross-trainer (very well made, good electronics, attractive) for $230 (delivered, assembled) in a local sporting goods store. I’m starting at 5 km and low tension and I’ll work up. I break a sweat so I think it is good. Between weights (450 reps), floor exercises (deep knee bends with weights, 3+ minute planks, sit-ups), and the machine I’ll be fit in no time. Recent studies demonstrate marked increased elasticity of arteries in anyone at any age who trains for and runs a marathon. I’m all for arterial elasticity.

As to DT, get out the vote and work for your candidate and, eventually, the Democratic nominee. What curs these duffers be! And how in the devil can George and Kellyanne occupy the same bed?  A freak pairing, like a lion and a lemur or those stressed elephants in ?India who were trying to mount rhinos.