Laos

More to come eventually...

Reasons I love Thailand - part 2

I think I was on number 5 in my last post... so here are number 6 and 7.

6. When was the last time you thought it was chilly at 22 degrees Celcius (72F)? Yes, today I went to leave my apartment and was surprised when it was chilly outside. I went back inside to get a jacket. There are two things that are lovely about what happened. First, the weather is typically so consistent here that I don't check the weather forecast - during the hot season, it's incredibly hot and I wear light clothes; during the rainy season, it's a little less hot and I wear light clothes and bring an umbrella; during the dry season, it's just hot and I wear light clothes. Second, I can feel refreshed when the temperature drops below 23 Celcius/73F (and keep my A/C at 27 degrees Celcius/81F (when I use it) and feel very comfortable).

7. I just got a "gentle reminder" email. When was the last time you got a message with the subject "gentle reminder" rather than "MEETING: 12 NOON, COMMUNITY CLINIC"? Really, which one looks nicer? Maybe this is why Thailand is the Land of Smiles?

Me, enjoying the beach at Hua Hin 

My awesome Christmas tree! (it's even better now because I bought flashing lights!)

Loy Krathong

Loy Krathong is one of my favorite holidays in Thailand... it's just at the end of the rainy season and the weather has finally started to cool off. Everyone gathers near bodies of water - natural or man-made - and puts small (or large) floats into the water to wash away bad things that have happened in the past year and hope for good things to happen in the next year. Here's a link to some more information.  

Suzy, Smitha, Kent, and Rebecca

A beautiful banana-leaf kratong, with candles and incense

Sharing a light ;)

My awesome krathong... made of ice-cream cones!

Me, getting ready to "loy" (float) my "krathong"

Lumpini Park's pond - I think the massive lizards were scared away,
but I did see one chomping on a float...

So pretty!

Doi Lanka Luang

More to come soon!

Immigration irritations

Let me start with a bit of brief explanation… in Thailand, you need two things to be able to stay in the country: 1) a visa, of varying type and duration, and 2) an entry permit, also of varying duration. So, I have a multi-entry, year-long education visa, but I still need to leave the country or check in with immigration every 90 days to renew my entry permit. There are long forum posts and discussions about this, but in general, it tends to confuse people. And, there seems to be a profit in confusing all those foreigners who don’t understand Thai immigration rules – with large, daily fines if you overstay your entry permit. I was pretty lucky last year because, 1) I applied for my education visa in the US, and 2) I traveled out of the country a lot. So I never really needed to deal with immigration, besides entering and exiting the country. However, that changed when I tried to research ways to get a new visa.

I tried to get a new visa before my old one expired (but that failed when ASPH failed to renew my contract before my old visa expired). So, I couldn’t leave the country unless I could guarantee that I could get a new visa in whichever country I went to. I wasn’t illegally in Thailand – I still had a month and a half left on my entry permit, but I couldn’t come back unless I had a new visa. With this in mind, I tried to contact several Royal Thai Embassies that had a good (blog) record of distributing education visas (because it depends on the country… urgh). Upon contacting Singapore, I was directed to the Ministry of Foreign Affairs, based in Nonthaburi, about 20 minutes from where I’m based. The ministry official made my day when he said I didn’t need to leave the country – I could just come to the immigration office 20 minutes from the MoPH and extend my current visa. All the paperwork was in order – I just needed one more letter (saying the exact same thing but with different letterhead). I obtained my third letter (saying the same thing) and headed to the immigration office, excited at the prospect of getting my visa extended but extremely apprehensive of the ease with which the extension was described. Visa issues are not easy in Thailand.

So, I found the office, had the correct paperwork, and got a number. And then the confusion began. The first immigration official thought I needed a work permit (which I can’t get because technically no one employs me). So she asked me to call my office so that she could explain to someone in Thai what I needed to do. When she got too confused, she passed me off to another official, to whom I tried to explain my situation (in English and in Thai). I referred to my previous contact with the Ministry of Foreign Affairs, but had no luck. She asked me to call my office, explained again that I needed a work permit, but also suggested that I needed to go to the Nonthaburi immigration office (40+ minutes away and in the middle of a rice field) because my fellowship is based in Nonthaburi. The office I was at (in Nonthaburi!) only served people living or working in Bangkok, technically another province. 

Massive government complex off of Chaeng Wattana (1st & 3rd stop)

 

Yes, so the dot in the middle is my office - the one northeast (and closest) is Chaeng Wattana's office. The one northwest (and across the river and in the middle of a rice field) is the Nonthaburi office.

 Nonthaburi Immigration Office... really, it's in the middle of a rice field!

The next day, I headed off to the Nonthaburi immigration office, this time with a Thai friend accompanying me. We found the office (eventually), waited dutifully, and were told again that I needed a work permit. After talking more, the officer suggested I go to Laos to get an education visa (really? You can’t give me one here?) or go the the other immigration office (yes, please, pass the buck on…). After more talking and several “goodbyes” from the immigration official, I was surprised when he started stamping things into my passport. Miraculously, he gave me an extension (to Sept. 15, which is technically the last day I work also…) but then said I needed to go to the other immigration office to get my 90-day entry permit. Ei! The next day, I headed BACK to the office 20 minutes from me, got my 90-day extension and finally relaxed.

 I'm legal - extended AND permitted!

World AIDS Day 2010

First, a note of caution: Normally, my posts are about life in Thailand, interesting news articles, random thoughts of the day, pictures from traveling far and wide. I try not to be political or post about things that are super controversial. But, it's World AIDS Day, so here are (some) of my opinions and experiences as life as an HIV researcher.

In honor of World AIDS Day 2010, I thought I'd share some of the interesting (and disturbing) reactions from people when I tell them what I do. As you know, I am an ASPH/CDC global health fellow working with the HIV Research Branch with the Thai Ministry of Public Health - U.S. Centers for Disease Control and Prevention in Nonthaburi, Thailand. The branch is currently conducting studies among injection drug users (IDUs) and men who have sex with men (MSM). I work with the group studying behaviors and HIV among MSM in Bangkok. This, however, is quite a mouthful and I tend to summarize by saying I work in HIV research. So with this in mind, the reactions:

1. "I hope you're not one of those people who think HIV is just in gay men." No, I'm not. Anyone CAN get infected with HIV. In Thailand, however, if you are a man who has sex with another man, you're much more likely to have HIV or to get HIV then if you're someone else. I'm not judging... I'm just saying, based on surveillance and monitoring the HIV epidemic in Thailand, this is true. This doesn't mean that MSM should be treated differently or unfairly. It actually means that, as a public health professional, I think Thailand should develop programs to prevent HIV in MSM and I think Thailand should provide support to people who have HIV. And, they are starting to. And, based on their 100% condom program, they might have success. I certainly hope so.
2. "Hmm, should I wear a condom?" Well, yes. Using condoms consistently and correctly is one of the most effective ways at preventing HIV infection. But, really, I'm not a counselor, nor do I appreciate having this conversation on an airplane. (Actually, the question I got from my plane seat neighbor was more disturbing.) There are some other ways to prevent HIV that are currently being researched that are looking more promising:
• Microbicides - see the CAPRISA 004 study - They demonstrated that a microbicide used by women in South Africa can decrease HIV transmission by up to 40%.
• PrEP (Pre-Exposure Prophylaxis) - see the iPrEX study results - They demonstrated that a drug combination (Tenofovir and emtriciticine) used daily can decrease HIV transmission by about 40% (and almost 80% in those who were very adherent) in men who have sex with men in Peru, Ecuador, Brazil, United States, South Africa, and Thailand.
• HIV vaccine - see the Thailand Vaccine Study - This was the first study that showed a vaccine had any effect in preventing HIV infections.
3. Blank stare. "Oh that's interesting." Averted eyes. Quickly change the conversation... These people tend to be, shall we say, more conservative than others. Sometimes, they think HIV is a disease that bad people get and that people who get HIV deserve to get it. In my opinion, that's bogus. No one deserves to get a life-threatening illness. What if I said your children deserve to get diabetes because they eat too much over-processed sugars. Both can be life-threatening illnesses that require life-long treatment. Diabetes isn't heavily politicized though and people with diabetes are rarely stigmatized. Diabetes programs aren't limited by politicians in providing evidence-based prevention and treatment programs. No one says, "Hey, I think we should pay for people who have diabetes to get insulin because I don't like needles." But it happens quite frequently in HIV programs. Here are just a few examples:
• Programs must spend a significant portion of their budget on abstinence education. Yes, I agree, abstinence is a great way of preventing the spread of HIV. But, it doesn't work by itself. Here's a pretty comprehensive review.
• Programs cannot set up clean-needle programs for drug injectors. Look, I understand the train-of-thought: Take away access to needles and drug injectors can't inject so they can't do drugs so they can't get HIV. But that doesn't work either. Providing clean needles doesn't make injectors use drugs more often, but it can link they with treatment programs, education, and improved awareness. More information
• Programs are limited in how they can promote condoms. There are a few lines of thinking that limit condom-promotion: 1) Condoms are a form of birth-control, which is prohibited by the Catholic church; 2) Condoms lead to promiscuity because if young people have condoms, they will have sex earlier or more often. I'm not going to address the first point (except by linking you to this article by the BBC on the Pontiff's latest remarks of condom use). The second point, however, is a bit absurd. It's along the same lines as the opposition to giving girls the HPV vaccine - if we give them the vaccine, they'll have sex earlier or more often. Really? Do you really thinking giving a girl a vaccine that can prevent a disease they may or may not get in 40 or more years will really prevent her from having sex now? Do you really think not giving a boy a condom now will prevent him from having sex now? Will all those thoughts of potential pregnancy (9 months from now) or potential for sexually transmitted diseases (which may or may not effect his health a few days to a few years from now) will prevent that? I think you're probably deluding yourself. Young people will have sex, regardless of the information or tools you provide them. So why not provide them with the best education and the best tools to prevent harmful consequences? Anyway, that's what I think.

And finally, some news from other sources on World AIDS Day 2010:

• Colleges Are Producing New Style of AIDS Activist
• An Enlightened Exchange in Iran
• Girl Child Network Worldwide marks the World AIDS DAY
• Medical advances in fight against HIV/AIDS