I can do that!

After we were finished with the morning clinic the children demonstrated their skills in measuring their height.

Curiosity

The kids were fascinated by our activities. There was nearly always someone looking through the window.

Down to Business

The long journey, expense and hassles endured seemed to evaporate as hundreds of children surrounded and mobbed us with hugs and hello's as soon as we stepped out of the truck. After 24 hours of flying, and sitting in airports, we arrived at the Akha training center, and the reason we were here was clear. Scores of kids grabbed our luggage and took us to our rooms. They all love to practice their english on us and they have soul melting smiles. I immediately noticed their teeth and skin were vastly improved over my first visit here.
The students and I were introduced to them and we are all making friends by the minute. We held the first day of clinic and saw over 260 children. The mission is to install a medical record database so we can document and follow the health of the children. Many of them are small for age and most have not been fully immunized. The problem is there are no records of most of the care they receive from various volunteer agencies. The myriad questions about their health will remain difficult to answer and manage without medical records. Since many of them are orphans we have little information on their family and past history. We are focusing on ROS and drilling down on issues found and documenting exams. While most are healthy kids with usual childhood issues we found several with significant issues, including cardiac arrhythmias, a mitral regurg murmur and several wheezers. Due to the smoke from the farmers clearing fields with slash & burn methods it is not clear if there is an underlying pulmonary problem. By having a chart to follow them we will hopefully be able to tease this out.
I am extremely proud of our students, they did absolutely yoeman work yesterday. Because of that we should be able to work at a bit more leisurely pace. One of the students is a dietician and will discuss ways of improving the calorie and protein in their diet. With that and growth charts we can begin to evaluate the questions about their size. I believe they are constitutionally small people and some also have superimposed malnutrition.
We will teach the older children the basic metrics and normal exam to continue updating the medical records. With it being web-based I hope to be able to continue to evaluate them from home. Perhaps the residency program directors will be interested in making this available to their docs. There is much to learn and give.
Time to teach more English. Today, "Whatsuuuuuuuuuuuuuuuup!"
KLF

"Whatup, Clinic Day 1"

Adam and Courtney gave the kids a taste of American culture this morning before breakfast by teaching them to say "Whatup!" (complete with hand gestures), and how to do a "pirouette en dedans."  (Adam also tried to help Courtney demonstrate this move for the kids, who found the whole thing to be hilarious).  Then the kids decided to see who could jump high enough to slap an over-the-head high five Saad, who at 6'4" is the tallest guy on our team, and a towering giant to the tiny Akha children.  I was amazed that these kids were so energetic after staying up to nearly midnight the night before, huddling on the pavilion in their brightly colored blankets and sharing a movie together.  I laid in bed exhausted from our travels and listened to them cheering and laughing together.  How fun it must be for them to be surrounded by friends and playmates all the time.

It was quite chilly at breakfast, much to our amazement, as the day of our arrival had been scorching hot.  Ivan called it a "paradox of atmospheric conditions," explaining that it was cool in this tropical climate due to the abundant "particulate matter" in the air blocking the sun's rays. (That was a lot to take in at 7am!).  This particulate matter is actually smoke created by the practice of "slash and burn" farming, which is an ancient farming technique widely practiced throughout Asia.  Farmers clear the fields the quick and dirty way by burning the underbrush and allowing the charred soil to lie fallow for a season.  Unfortunately, this practice creates lung pathology in young children, which we saw in our clinic today in the form of wheezing, coughing, rhinorrhea, and epistaxis.

Clinic began at 10am today and ended around 6:30pm.  We were able to see 269 of the 430 children!  We are very happy to report that 232 of these were deemed "normal" exams, as the only physical findings were nits and dental carries.  (Many of us began to feel our own scalps start to itch as we meticulously examined each child's scalp!).  Jaimie came up with the great idea of using the children's own hands to "help" her find the nits.  Only 37 exams were considered abnormal: 2 children would need a nutrition consult, 13 needed dermatology, 12 had a URI/strep throat, or otitis media, 2 had questionable GI bleeding, 4 had cardiac pathology on physical exam, 2 had questionable GI worms, 1 had tachycardia and hypertension, and 1 needed follow-up for his long-standing seizures controlled with Dilantin.  (This child also happens to be sponsored by Dr. Ferguson).

We were able to cover so much ground today by splitting strategically into groups.  I heped the nurses with vital signs and triage; Jaimie, Haney, and Ivan set up shop in one of the classrooms; Peter, Quincy, Jenn, and Saad in another; and Courtney, Adam, India, Erin and Angela in the other.  Will photograped the whoe experience, and Dr. Ferguson ran between the rooms to supervise, confirm abnormal physical findings, and hep develop treatment plans.  We also had some lovely high school aged Akha girls volunteer to be our translators for taking the histories.  One of the teens, Api, told us she wants to be a doctor when she grows up.  She also happens to be an excellent artist and drew pictures of the Thai landscape throughout the day.  We were all exhausted by the end, but thrilled to have found Akha children so healthy and happy.

---Kristen

The Akha Training Center

After 5 hours of much needed rest, we awoke this morning to our first full day in Thailand! We enjoyed a nice breakfast at the hotel and left for the airport to catch a flight into Chiang Rai that we had not yet booked. It was somewhat of an amazing race to find the cheapest tickets! Luckily we were all able to find round trip tickets from Bangkok to Chiang Rai at the last minute. The flight into Chiang Rai was about an hour. Upon arriving at the airport, we were greeted by David Stevenson and some of the children from the Akha Training Center. The 17 of us, along with the 5 of them, loaded into 2 small trucks and began the one hour long drive to the center. For some of us the drive was an exciting experience, as we were piled into the back of the trucks with luggage and groceries going at least 60 miles per hour on winding roads. While those of us in the backs of the trucks did not have the most comfortable seat, we definitely enjoyed the best view of the amazing landscape!

Once we arrived at the center we were greeted by hundreds of smiling children from the Akha tribe. They all rushed to grab our luggage or simply grab our hand and lead us around the center. We were served a delicious dinner of rice, chicken and vegetables by some of the children. Afterwards we watched all 400 plus kids enjoy a time of devotion and singing. When they were done singing, it was our turn. We introduced ourselves one by one to them and then sang the song “If your happy and you know it.”  

Our original plan was to hold a vaccine clinic this evening, but we have not yet been able to get vaccines. We are still working on this and hopefully we will be able to purchase the vaccines and administer them to the children before leaving. So far, now the plan is to get some rest before starting a long day of clinic tomorrow! We will start clinic after breakfast and our goal is to examine around 150 children in about 12 hours.

---Quincy

I've got Seoul

We are half-way through our travels and maxin' in the Rest n' Relax area at the Seoul Korea airport. We didn't get into the nicer lounge because we weren't "elite" members (I knew I should've worn my tux). After checking our email at the free WiFi spot (where you at ATL airport?!?) we decided to get some real authentic food. After finding a squid swimming in Kristen's soup, Courtney got a 15cm Subway sub and I opted for a Whopper meal. I was slightly offended that the cashier at the BK asked me to pay "five dollars" instead of whatever the local currency was (I didn't check) like everyone else had to pay. I was even more enraged that after profiling me as an American she still only gave me one ketchup packet. I thought to myself, maybe she's had a long shift and politely asked for more. I received a second ketchup packet; I politely asked for more. It was at this time that the manager came to the front to see what was going on. I explained the situation to him and offered to pay whatever kind and amount of money to get a sufficient amount of ketchup packets. Fortunately he was delightful and gave me an American handful of the most amazing, high fructose corn syrupy ketchup of the day. I bowed and went on my way to eat my Seoul food. 

The flight to Bangkok was uneventful. Between naps I had woken up to eat, drink, and fall back asleep. The high point of the flight was the Red Carpet Cheesecake ice cream for dessert; the low point was accidently catching a glimpse of the movie Twilight on my way to the restroom. When we landed in Bangkok and proceeded to customs I was quickly reminded that I am not a US citizen and was delightfully asked to leave the group and head 

back to get a visa. Since there were armed guards walking around

I figured I would just do what they said. When I got to the visa parlor I waited in line behind a large group from China. Five sweaty minutes later I was informed that there was a form I needed to fill out behind where the line starts; I did. Ten nervous minutes in line later I was kindly asked to provide a photo for the visa. Hmm. Where did I put those passport photos... Oh yea, in my imaginary "never got 'em" pocket. Luckily, there was a photobooth a few miles east and, yes, you guessed it, they only take Baht and nath the US dollars. A currency exchange booth was conveniently located back at the visa shop. A few long moments later I was reunited with my American group and we were on our way to our hotel. 

At the hotel we were warmly greeted and quickly showed to our rooms. The rooms are very nice and modern, and include a kitchenette and flat screen TVs... very snazzy. After we got settled in we showered up (except for India and Angela... P-U) and got ready for the big adventures that tomorrow will surely bring. Stay tuned...

Adam Vytykac

And we're off!

We're almost there!  22 hours down and 8 more hours to go (I think... the time changes are a little confusing).  But, we've made it successfully to Seoul, South Korea.  We left Gainesville this morning... or I guess that was yesterday... with no bumps or troubles.  With a few hours to browse in Atlanta, we prepared for our 15-hour flight.  We actually flew straight north over the North Pole.  India happened to glance out and see icy peaks.  I was asleep.  We then flew south over Russia and probably China, but avoiding North Korea.  A passenger told us that North Korea has threatened to shoot down any South Korean flights over their borders.

We flew on Korean Airlines and the service was excellent.  I have to say, the flight attendant's outfits are pretty cute, too (see right).  I had two meals, took a snooze, took an occasional lap and watched 3 movies to pass time.  Overall, it was good except for when I got nautious on our descent.  I asked the attendant for a barf bag and she gave me a huge shopping bag instead!  Thank goodness I didn't end up needing it!

Everyone is roaming the airport now for food and money exchange before our last flight.  This airport has free wi-fi and couches to lounge on, unlike Atlanta!  It's pretty comfy!  Whew, this is a long day/s of traveling.  Nap time!

--- Courtney