Happy 60th Anniversary, King Rama IX!

We noticed the bright yellow wrist bands when we were in Chiang Mai. A la Lance Armstrong, they're being sold to honor the King's 60th Anniversary by the banks. Then came the flags. They're everywhere -- bright yellow flags with the King's crest (yellow is evidently the King's color, having been born on a Monday), usually accompanied by the flag of Thailand. People are hanging them on their gates, along the roadways, on major buildings, often with portraits of the King. Last week came the shirts. Most of them are Izod style golf shirts (very popular here) -- bright yellow, with the king's crest emblazoned on the pockets. On the first day I saw them, I must have counted two dozen in my short trip to work. Like everything in Thailand, there are "real" ones and knock-offs. The real shirts can only be purchased at places like the Grand Palace, with all proceeds going to the King's community development projects. The knock-offs can be had on any corner in Bangkok. (Real ones come with a golden King's crest sticker, and have a green stripe on the inner collar -- I know, having just purchased one to the delight of the sales people in the Grand Palace shop. Thais love when farang appreciate their King.)

In a country that regularly adores its King, Thailand is going king-crazy. King Rama IX will celebrate his 60th year as monarch this June -- perhaps the longest sitting King in history. Unlike the British monarchy, there's nothing but reverence for the King in public here, though it's illegal to write or say anything negative about the monarchy. But regardless, Thais really do seem to love King Rama IX. Places he's been (including wats, food stands, official monuments, community development projects) all proudly display pictures of his visit, detailing when and why he came, and the honor he bestowed upon the monks or villagers or citizens by his presence. He's an accomplished saxophonist who's played with the likes of Benny Goodman (chronicled in photographs in one of the King's mansions). He is also a skilled photographer, and often takes pictures of the communities he visits -- of the children, of the farming projects -- documenting and chronicling the needs of his people. By all accounts of those I've worked with here, he appears a truly humane and progressive presence in Thai society.

I'm going to miss the royal barge processions and the celebrations which will begin in late May. But I join the Thai people in wishing their King a very happy anniversary! May he live a long life and continue to bring wise counsel in this nation's turbulent times!

Through The Lens of Harm Reduction

The last two months I’ve been fortunate to have been given the opportunity to see the world through new eyes – through the eyes of former and current IV drug users and their community. Their professional framework is harm reduction; a distinctively different lens than Free To Grow, whose focus was less on the user, and more on the impact of use and abuse on families and communities. While Free To Grow’s work certainly included strategies to provide support to those experiencing the negative consequences of addiction, its bias was undeniably towards abstinence, at least in the case of drugs. After all, as many in the community reminded us, the sub-title was, “Head Start Partnerships to Promote Substance-free Communities.”

The community in which I have been living would argue that use, whether it be alcohol or drugs, has been part of society since its beginnings, and that abstinence is an unrealistic, and not necessarily legitimate goal. That people can make informed choices about their use, and should be encouraged to use in a way that doesn’t harm themselves or others. That the line between legal and illegal drugs is often fuzzy and arbitrary – that marijuana is no more dangerous used in moderation than alcohol or legal amphetamines and anti-depressants. That drugs like opium, heroin and cocaine have historically been used responsibly, and, like alcohol, are only problematic when misused or abused – and subsequently bring harm to individuals, their families and their communities.

As a field, harm reduction is committed to putting in place strategies that are open and accepting of all persons – that don’t demonize or stigmatize people for their drug use, and meet people where they are. In a world where the transmission of HIV through infected needles is one of the most significant sources of new HIV cases and AIDS deaths, it’s easy to feel the discrimination and punitive nature of policies that don’t permit clean needle exchanges. People shouldn’t die just because they’re drug users. We don’t put policies in place that are life-threatening to people who smoke or drink to excess. Yes, these behaviors are legal. But the fact that prostitution is illegal in Thailand didn’t stop the government from launching a broad-based pragmatic condom distribution campaign for sex workers, reducing the prevalence of HIV in sex workers and their partners dramatically. (Of course, the cynical take on the decision to distribute condoms to sex workers could argue that the government was worried less about the sex workers than their clients, who represented all walks of Thai society, to say nothing of the Western men who have for years flocked to Thailand to find the girls of their dreams.)

Some aspects of harm reduction have been easy to embrace: that all people deserve to be treated with respect, that all deserve equal access to preventative measures that can reduce the harm of their risky behaviors, and all should have equal access to ARV and other health treatments if they are sick. It’s easy to see a world that is filled with double standards regarding use and abuse, with wealthy people able to check themselves in to Betty Ford if their use becomes out of control, while poor people more likely to land in jail, without access to humane treatment options. Harm reduction, at its core, demands equity.

Yet, the little time I’ve spent in the harm reduction world has also raised many questions for me. How much use is too much? And who decides? If it is up to the individual, how does one deal with the denial that is often part of addiction? These are not only my questions, but questions that come up day after day in my work here. If an organization is committed to hiring former and current IV drug users, what happens when people begin coming to work too high to function? What is the appropriate intervention? And what of the impact on families and communities, particularly of drugs like methamphetamine or yabaa (or “crazy drug”, as it is called here) which destroy brain cells and increase violent behavior? How effectively does the harm reduction community speak to the crime that is sometimes related to securing money to purchase drugs?

These are not easy questions, and I have engaged in many discussions with those with much greater expertise and background in the approach than me. They, too, acknowledge the complex nature of the issues – that accountability and responsibility are just as much a part of the equation as compassion and acceptance. There is a danger of romanticizing “responsible use”, and turning away from some of the more difficult consequences of any life that includes a reliance on intoxicants – legal or otherwise. But it is a complexity that is, I think, too often neglected, and whose perspective brings a more nuanced framework that could bring greater honesty to our broader prevention work on the ground.

Songkran: The New Year Thai Style

We have been drenched for four days now. It is Songkran, the Water Festival, the lunar New Year in Thailand. We are in Northern Thailand in Chiang Mai, where the Water Festival originated – and it is celebrated with abandon here. A walled city, with moats on all sides, one cannot walk ten feet in the Central city without being “blessed” with water. Young children and their parents line the streets with buckets and water guns, pouring water over the shoulders of passers-by wishing them well in the New Year. We have taken to returning the gesture – reaching into young children’s buckets and sprinkling water on their shoulders, as we say, Sawasdee bee mai kah! (Happy New Year!) The children giggle, their elders smile, and bless us, clearly happy that we understand that the water is meant to be more than just an opportunity to get cool in the hot season.

Teenagers and young adults get a little more exuberant (fueled by much drinking and merry-making), turning hoses on people, and splashing one another from the backs of pick-up trucks armed with trash cans filled with water. Go-go girls dance on stage platforms, showering the crowds below while rock and roll blares on the streets. Young farang (Westerners) have embraced this rowdier side of Sangkran – with an energy akin to Spring Break in Fort Lauderdale. They crowd the streets lined with bars in short shorts and tight tee-shirts, pouring ice water down the backs of one another and anyone else who gets close enough to be an easy target.

Religiously, Songkran is a time of cleansing – of washing away bad karma, of starting over, of making merit for luck in the New Year. Chiang Mai is home to over 300 temples. Side by side with the city-wide water fight are more traditional water rituals – the procession of the Buddhas outside of the temples, so that the people can shower them (and their elders) with water. The bringing of offerings from the local provinces and towns to the governor of Chiang Mai, with hill tribes dressed in their finest clothes, bringing their best harvest fruits as gifts. There is plenty of water here, as well – splashed with more reverence and blessings, but just as wet.

Unlike the famous temples we have visited in Bangkok, which border on tourist attractions, the temples of Chiang Mai are packed with people during Songkran – bringing offerings to the monks, saying prayers for their ancestors, snapping photos, making merit. Children from local traditional Thai dance schools perform for their families and friends, and are awarded with presents for their efforts. The temples feel close to the people here – not separate and distantly sacred, but a central part of daily life. There is a familiarity, a connectedness that we have not yet experienced. We are welcomed in almost every temple we visit, invited to be blessed, offered fruits and sweets to give to the monks. And of course, we are, once outside the temple walls, met yet again, by another well-wisher, joyously dousing us with water to honor the New Year.

Voodoo Economics

Everything costs a dollar here. The bottle of water that costs 10 baht (25 cents) in Thailand is a dollar in the Cambodia for tourists. The trinkets that street children hawk at the temples all cost a dollar, or two – for origami animals, or bamboo bracelets, or postcards to write home. The cab ride from the airport costs five dollars, a driver twenty-five – small sums by American or European standards but large sums in a country where most people make a few hundred dollars a year. Our hotel room, in a guest house not yet consumed by the new economy, costs only twenty dollars a night. Yet, down the street, in one of the dozens of new hotels that have been built in the last two years, a different trend is emerging – as rooms can now be found for over $500 dollars/night.

It is a disorienting experience being in another country – particularly one where the poverty is so great – where the preferred currency is the American dollar. In Siem Reap, the town on the outskirts of Angkor Wat, everyone wants to be paid in dollars, but will give you change in riel (which are now trading at 4000 to the dollar) if you do not ask otherwise. Because American coins are not used, the baseline starts at a dollar and goes up from there. This creates a distorted kind of inflation – with many things costing more in Cambodia than they do in its much wealthier neighbor, Thailand. I’ve grown unaccustomed to paying $5.00 for a cab ride, where even a fare to the airport won’t cost you that from my neighborhood in Bangkok. I find myself constantly comparing Thai and Cambodian prices, and feeling somehow that the fact that things are being priced in dollars has created a system with no rationale and consistency. It’s hard not to feel taken, even when the amounts are small.

It helps to get some distance and perspective, particularly with the animated entreaties from the street children. They are smart and engaging -- offering to tell you the capital of the state where you live if you promise to buy from them. They count the bracelets around their arms in English to show you that they can. They ask your name, tell you theirs, and promise to remember you when you return from visiting the temple (and they do!) Yes, the bracelets they are selling aren’t worth a dollar in Cambodia, or probably even in the US. But isn't it worth it to give a child a dollar anyway, if it will pay for school uniform and materials fees for nearly ten days? The answer to this question seems simpler, and not filled with issues of worth. I am not buying bracelets, after all.

Bad Policy: Good Consequences

The organization is called Korsang. Its staff: former Cambodian American gang members from the streets of San Diego, Virginia, and Kentucky—deported as “undesirable aliens” for crimes committed in the US. They are the children of Cambodian refugees whose families fled after the Vietnam War and during the Pol Pot regime. They have names like Wicked and Snot. They are in Cambodia because their parents, not understanding American citizenship rules, neglected to file naturalization papers for them. Thus, they are eligible for deportation based on the guidelines of the Patriot Act. Raised as Americans by Khmer parents, they are more hip-hop generation than Cambodian – former Bloods and Crips who know the laws of the street, and dance to the beat of the urban inner city.

But here they are – on the dusty streets of Phnom Penh, staffing a drop-in center and harm reduction outreach program that is the vision of Holly Bradford, a former IV drug user, and harm reduction expert from Boston. Grandmother to a Cambodian grand-daughter, she came to see the country of her grandchild’s roots, and has basically never left. Meeting the young deportees, she saw something different – not “undesirable aliens” or gang members – but young men who understood something about what it meant to be marginalized. Young men who knew something about the streets and what it takes to survive, and who wouldn’t be afraid to go out and try to reach others whose lives were even harder than theirs.

They are a family now – supporting one another, laughing, crying, and partying together. By day, they work with a team of trained peer educators to meet the needs of the IV drug using population of Phnom Penh, hoping to stem the spread of HIV and HepC. The outreach team provides clean needles, collects used syringes, distributes condoms, helps access HIV testing and medical care. In the Center, young users hang out, watch television, sleep, learn English, eat and talk. The staff’s American backgrounds have worked to their advantage here – giving them cache, and a mystique that is appealing to those they are trying to reach. Break dancing classes are a particularly hot activity, with street children as young as four and five twirling on their heads with abandon.

To do their work, Korsang has built relationships with the police, local NGO’s, and the American Embassy, who despite the irony involved, is an ally and supporter of these young Americans who have been thrown out of their country. Their work has been featured numerous times on the front pages of the Cambodian papers, and visitors and reporters now flock to hear about their successes, which are significant. In just a couple of years, thousands have already been reached on the streets, with broader networks and more comprehensive one stop health and education services envisioned in the future. When asked, none of the young men of Korsang could have ever imagined their lives to have taken them on the path they now travel. But for many, they have come a long way to find their way home.

City of Ghosts

People say that ghosts haunt the bridge over the river; that it's not safe to cross at 11:00 p.m. and 1:00 a.m. Our guide in Siam Reap shared that many Cambodians won't live there -- too many hungry ghosts from the Pol Pot era. Driving around the chaotic, dusty back streets of Phnom Penh in a tuk-tuk, Elaine and I could feel it in the air -- something unsettled and lawless. And yet, Phnom Penh is also a city of wide, beautifully landscaped boulevards that resemble the avenues of Paris built in the French colonial period. There is something eerie about the combination of the impact of Pol Pot and the French. This is the city of the killing fields, with skulls piled to the sky in a stupa in memorium, and clothes still rising through the dirt in the fields where mass graves have yet to be uncovered. In Tuol Sleng, the prison museum, the walls are hung with hundreds of photos of the dead, catalogued by their torturers with the same twisted conscientiousness of the Nazis. The photos represent but a fraction of those who died. All of the Cambodians we met had lost family members during those terrible years.

Out of this history of colonialism and evil has emerged a country without infrastructure -- the folks we visited shared that there is no government to speak of, no health budget, and corruption is the norm. The country's health infrastructure is run by the UN, the French, the Japanese, the Belgiums and many others. Many schools and children's progams are run by foreign governments or NGO's. People sponsor street children, paying to send them to school to try to secure a brighter future than the garbage dumps for them. There are foreign workers everywhere. In the short time we were in Phnom Penh, we ate more Western food than I'd eaten in two months in Thailand.

Phnom Penh is also a city of opportunity and refuge for many who need or choose to leave their former lives behind. Sitting in a bar overlooking the river, talking with American deportees and expats from around the world, we could have walked into a scene from Casablanca -- American and Cambodian rock and roll playing in the background, talking about times past and new beginnings -- it seemed almost as if time had stopped. The ghosts were quiet for a moment, whispering only in the breeze.

Rice Paddies and Water Buffaloes

So I’ve finally seen Thailand. Not the five story malls of downtown Bangkok that rival anything in the US, including Rodeo Drive. Not the Starbucks, McDonalds’ and KFC that now compete with the night markets for young Thai’s business. Traveling about six hours south to the small city of Chumphon , I saw my first rice paddies, water buffalo and rubber plantations – the Thailand of the picture books of my youth. The landscape is dramatically more jungle-like, filled with big palms, banana trees, and houses set up on stilts. In the south, the spirit houses seem to come in pairs – one bigger and set taller, another smaller and set lower to the ground – almost like mother/daughter bungalows – often painted in matching colors, and with elaborate offerings. They are, I am told, supposed to appease two different groups of ghosts – those of the heavens, and those of the earth.

Chumphon is by the sea. We were there to facilitate a leadership training for members of the local PLWHA group. Our first night, group members took us to visit the central shrine of the city – a shrine honoring naval heroes who protected the city over its history. From the shrine, one looks out on the sea and to the islands off the coast. These are the islands where locals climb the cliffs in the dark to collect swiftlets’ bird’s nests – a great delicacy in Asia. Not yet developed as a tourist area, the Chumphon beaches are sleepy and quiet. We had dinner outdoors by the beach. While people ate and sang Thai movement songs to Ott’s guitar playing, we watched the squid fishermen’s boats line the shores off the surrounding islands. Dogs slept in the street. Stray cats visited, looking for leftovers from dinner. Under the stars, with voices raised in song and the wind coming off the beach, we seemed a long way from Bangkok. Yet the idyllic nature of the setting masked the common struggles that group members in Chumphon share with thousands around the country. While they are infinitely better off than many PLWHA around the world, many had talked that day of facing stigma and discrimination, and of being less able than their peers in the city to get access to second tier ARV drugs if first tier regimens don’t work for them. This, too, is the Thailand of picture postcards – and even here – KFC, like HIV, is coming to every corner.

No One Walks in Bangkok

A New Yorker at my core, I’m used to walking all the time. It is the way to live in a city, the way to see and experience it. Bangkok challenges this basic premise of city life. On its face, Bangkok should be a great place to walk – it’s got terrific and interesting neighborhoods, wonderful back lanes to explore, and a 24/7 lifestyle. But no one walks in Bangkok (at least not any serious distances). It’s too hot. It’s too polluted. There are too many cars and motorcycles everywhere. Even many of the back lanes have narrow, if any, sidewalks. And if this weren’t enough of a deterrent, the slip on sandals one is inclined to wear in an environment where you’re regularly taking your shoes on and off to enter homes and offices aren’t the greatest for striking out on a stroll.

I’ve been determined to walk anyway. Early in my stay here, not able to find an available taxi near my office during the evening rush hour, I decided to walk instead. I’d traveled the route enough times to know that it was definitely a reasonable walking distance. Despite the crowds around the evening markets and movie theaters, it took me about forty minutes. True, it wasn’t totally a pleasant experience. But it felt good to be out on the streets, even if the exhaust and street smells weren’t the nicest. And I’ve discovered – now that I’ve walked the route at least a half a dozen times – that each time, I see a little more. Stopping along the way, I’ve begun to be able to make out which vendors sell what types of food (each has its own specialties, which can be discerned by the array of raw ingredients in the carts.) I’ve got a good idea which are the most popular by the consistent lines waiting to place orders. I’ve learned to tell the uniforms from the different schools apart by the pins and logos on the shirts and blouses that students wear. I’ve gotten immense pleasure anticipating the kinds of offerings I might see at the spirit houses in front of the IMAX theater, where young moviegoers often leave Slurpees purchased at the nearby 7-11 or cans of orange soda to appease the ghosts. And, if truth be told, I’ve enjoyed the incredulous reactions of the TTAG staff, who now regularly ask, “Did you walk home again last night?” when I answer, matter of factly, “Of course I did.”

More Than Just a Project

It’s close to midnight, and I’m sitting on the floor of Ott and Karyn’s home with some of the leadership of the Thai Drug User’s Network. There are papers strewn everywhere, and two or three laptops open and running. We’re talking about a document I’ve been working on to help TDN think through a restructuring of the roles and responsibilities of their Board and staff. We’re drawing organizational charts, with circles and arrows, translating as we go, talking about ways to consolidate roles and improve communication. They’re preparing Power Point slides to share with fellow network members later in the week at their Board meeting. They are almost embarrassingly thankful for the time I’ve spent helping them. I, however, am profoundly moved by the scene of which I’m a part. Taking a step back, knowing the discrimination that IV drugs users face in Thailand (as well as so many other places), I find myself wishing I could take a picture of them stooped over their laptops in the middle of the night, poring over documents not even written in Thai and publish it somewhere – a striking portrait with the power to undercut deep stereotypes.

Working with the Network over the last week, I don’t want to paint a romantic picture of the members. They are people who have lived difficult lives. Some have been in prison. Some are in recovery. Others use. Many are HIV+. Watching their interactions, I’ve remarked that it sometimes feels like the culture of the therapeutic community (of which many have been a part during their lives) and Thai values of saving face clash in difficult and complicated ways as members work together. Yet, I’ve never worked with a more dedicated group of individuals with deep commitment to their cause. While they welcome the resources and visibility that have come from their recent Global Fund grant, their dedication clearly has nothing to do with the project. The importance of their work – and getting it right – is not theoretical to them. It is their lives – and the lives of their friends and family that are at stake.

Tee-Shirt Mavens

Ott’s got an original Act-Up tee-shirt, given to him by one of the founders. Goi wears GMHC tee-shirts when she washes the floors of the office. And on Friday, Seree was wearing a tee-shirt take-off on Addidas, which has the company’s logo with the word “Addicted” underneath. (Karyn told me she and Ott brought them back from New York the last time they were there.) Then there are the dozens of tee-shirts that were produced around the time of the Bangkok International HIV/AIDS Conference in 2004 – demanding an end to medical apartheid, and equal access to ARV therapy for developing countries. And the harm reduction tee-shirts, with messages about safe injecting, and not sharing needles. And the tee-shirts about prisoner’s rights, and safer sex. One of my favorites is TNP+’s (The Thai Network of People Living with HIV/AIDS) – it’s bright red, with a line drawing on the front that says (in English) Positive Friends, Positive Life. I asked Kamon, one of the members of TNP+ why the message was in English. Ott replied, matter of factly, “because people think English is cool….” Indeed, observing the dozens of tee-shirts worn by the folks I’ve been around confirms the preponderance of English slogans. While some of the tee-shirts are, in fact, from the States, many others are made here – and often have English messages on the front, and Thai messages on the back. But no matter what the language, the advocates here in Thailand are real tee-shirt mavens, with an international flair for getting the message out.

When Words Fail You

I’ve spent a lot of time in the last few weeks sitting in meetings conducted in Thai. In most circumstances, I’ve not asked people to translate for me, relying instead on an occasional sentence repeated in English, or a summary I’ve received during meeting breaks. I’ve taken this approach to avoid disrupting the flow of work, and having my presence become a burden. Of course, meetings in which I’m directly involved require more translation. But participating in meetings where you don’t speak the language provides an interesting position from which to understand organizational culture. I’ve become very attuned to body language, and to the flow and rhythm of conversation – who talks to whom, whether staff are engaged in parallel discussions with leadership, or whether they’re talking amongst each other. I’m also gaining a better understanding of the rhythm of language here, and of patterns of conversation. Meetings are much longer than in New York. And even without understanding exactly what’s being said, it’s easy to understand why. People speak much more slowly (I’ve observed that folks raised in the North speak even more slowly than those raised in Bangkok, a fact confirmed to me by some of the staff who aren’t native to Bangkok.) By comparison, New Yorkers speak a mile a minute. Even Karyn, who speaks as fast as most New Yorkers, slows down considerably when she speaks Thai – not because she’s searching for words – she is amazingly fluent – but because the language is more gracious, and seems to demand greater care when speaking.

People also seem to pause more between speakers. You could probably count to three from the moment one person stops speaking, and the next one begins. By New York standards, this sometimes seems an eternity. But I’ve also found it quite respectful – the space a recognition that people are listening and trying to absorb what’s being said by others. I’m actually surprised at how much I do understand – partially because the concepts are familiar, and partially, I think because, when words fail you, it becomes incredibly clear how much of what we communicate doesn’t require words at all.

The Language of Advocacy

Listening to the advocates here in Thailand, I have been struck that they speak a different language than the advocates in the States. It is the language of human rights, of human dignity. Wassawut Yimchaem (Wut as he is called here), speaking at the Chiang Mai meeting, described his recovery process in the universal language of human dignity. “I learned to be in relationships; this is very important for any human being,” he said. “We are human beings; we have the same needs as anyone. We need love, friends, family. And like everyone, we have some things to work on. Some things bring us happiness, and some bring us pain. We have the right to live like anyone else. This is why we formed the Network.” Ott, like Wut, speaks the language of human rights – these are the fundamental values that drive TTAG and TDN. Their message is simple and compelling.

At dinner after Wut’s talk, I shared my observation that US advocates did not often frame their message using human rights language. “Of course not,” shared an Australian public health professional, now working in Cambodia. “The US still won’t sign the International Declaration of Human Rights!” It’s not a language that resonates in American politics. The consensus was that the US dialogue is more about right and wrong – bringing a relative morality to the argument. We should care about the poor because it’s the right thing to do; it will make us somehow a better person, a better society. The language of equity seemed closer, yet also distinctive from the human rights message. Yet, the advocates with whom I talked all agreed – no matter what the language, there was still plenty of work to go around, wherever we lived!

The Burden of Success

This past week I had the opportunity to join Karyn and Wut (a member of the Thai Drug User’s Network – TDN, for short) for two workshops they were presenting to a week long training course conducted by the Asian Harm Reduction Network in Chiang Mai. The sessions included health care and NGO representatives from Thailand, Cambodia, Vietnam, Myanmar, China, Taiwan, Indonesia and Pakistan. They had come together to learn more about issues of health and social care for people using IV and other drugs. Many worked on issues related to access to ARV and comprehensive health care for PLWHA who were current or former IV drug users. After listening to doctors and policy makers for the first part of the week, Karyn and Wut were there to bring the perspective from the ground – Karyn to provide background and history regarding the formation of the Thai Drug User’s Network, and Wut to share his story as an IV drug user, and as a founding member of TDN. As many people remarked after the sessions, they were the first presenters who really brought a clear vision of the challenges of actually doing this work. After all, what good was it knowing about the fifteen different drugs now available for HIV if only a quarter of them were actually accessible to most PLWHA in Thailand? What difference did it make if methadone clinics were set up if the protocols didn’t reflect the lessons that those who had tried methadone had experienced in earlier programs?

That Karen and Wut’s presence at the meeting was important was undeniable. It was critical that their perspective be heard. Yet, like many successful community advocates in the United States, TDN and TTAG are overwhelmed with requests to “tell their story”, so that health care professionals and policy makers can understand “what it’s really like” as they make decisions regarding the community’s future. One of the reasons that Ott founded TTAG was to grow the field of community advocates so that there would be hundreds of people around Thailand able to bring their voices to national and international policy and practice. Yet, there are still not enough. And advocates who are particularly persuasive, and who can speak with passion and clarity, are particularly in demand. In the two weeks since I’ve been in Thailand, Ott and Karyn have received more than half a dozen requests to speak or present. The requests come in from all over the world – the US, France, the Netherlands, Canada, India. They also field daily calls from people visiting Thailand who have heard about their work, and would like to have dinner and talk about what they’ve learned.

Ott and Karyn’s appeal, no doubt, is not only the unique skills each brings to their advocacy efforts, but also the ability they have together to bridge the cultural divide – each of them able to speak both from their hearts, as well as in the language of international program and policy. It is a hard decision each time they are asked to speak. Is there anyone else? How often can they be away without their own work suffering? How much visibility will come of this request? How important is it for achieving their goals? It is their dream that soon there will be many others throughout the world who can speak, so that their phone and e-mails won’t be packed with requests to be – once again – the ones who must tell the story one more time.

Bangkok Commerce

You can spot the hotel and tourist trade employees everywhere. They are the ones on the Skytrain wearing “traditional” Thai silk jackets and long silk skirts or slacks among the sea of denim and Mickey Mouse tee shirts. Perhaps they are even white gloved – an affectation that evokes images of British colonialism for me (yet in a country that was not colonized?). Their job is to create an “authentic” experience of Thailand for those coming to visit. They work in hotels like the Oriental, where I stopped for a late afternoon drink to get out of the heat while sightseeing over the weekend. It is a beautiful hotel, with river views and sprawling verandas. I was very glad to be there. Yet, apart from the views of the temples and the river ferries passing by, I could have been in the Grand Wailea in Maui or the Condado Beach in San Juan. The ambience was serene, hotel workers everywhere attending to those at the pool or on the decks. It could not have felt further from the teeming streets of Chinatown from which I had just come. There, everything and everyone was moving. Hawkers, street vendors, and thousands of people crowded the streets. Everyone was trying to sell you something – enough dried mushrooms to last a year (very good bargain!!), loose tea guaranteed to bring long life and vitality (a sample could be arranged….), balloons in packs of a thousand, garage tools, pots and pans, and any of thousands of options for lunch or a snack.

Indeed, as I travel to different neighborhoods around the city, it is the unrelenting and ceaseless commerce that amazes me. There is not anything that cannot be sold from a piece of sidewalk or a cart – from knock off designer watches to gems and Buddhist amulets. Walk the streets of Sumhamvit, and tailors summon you in every door, calling “Madam, madam” after you as you walk down the street, “can make you something very nice, twenty-four hours, no problem…”. Stop for a second to look at a pillow cover or embroidered cloth at one of the thousands of booths that line the streets, and the calculators are already in hand, ready to offer you a better deal than the vendor in front or behind them. Even the temples have their own kind of commerce, as people approach you, introduce themselves as students, and offer to assist you in finding your way through the gate of the wat at which you’ve already arrived.

I find myself searching my memory for a comparable American experience and wonder – the Lower East Side at its height? Jackson Heights on a Sunday afternoon perhaps? My hosts confirm that many of the street vendors are farmers displaced from the countryside – an immigration of sorts fueled by a changing economy and need to make a living. In that sense, it is, in some ways, Thailand’s version of my own grandparent’s migration, and the urgent tenacity to make it in a new world.

The Changing Faces of My Neighborhood

I've traveled the streets of my neighborhood -- a district that is part of greater Bangkok -- at many hours of the day and night now. It is never the same. Street vendors appear and disappear -- their wares sold only at dawn, or in the late evening hours. Whole discount markets emerge from almost no-where as evening falls, only to be gone the next morning as I taxi by to work. Even sidewalk restaurants are temporary -- there for lunch, gone for dinner. The facility with which businesses come and go seems almost a metaphor for the Buddhist foundations of the culture -- nothing is permanent, everything is emptiness. I'm delighted to find new things each day, but sometimes mourn the vendor whose morning dim sum is nowhere to be found if my timing is off. The locals understand the patterns well. The stalls of the indoor food market are crowded in the AM when the stands are filled, empty in the evenings when things are closing down.

Poor and rich seem to live side by side in this part of Bangkok -- my apartment building, filled with middle class Thais and some foreigners (many of whom seem like they might be missionaries) has a garage filled with new cars, and people coming and going with briefcases and laptops. Next door is a tin shack shanty town filled with the families of workers who are building a large new house on the lot next door. Their lives are lived publically -- food cooked outside, and televisions hooked up to outside lines and shared. There is a University not far away, and the Internet shops are packed with teenagers playing video games day and night. And though I've not ventured there yet, one of the biggest cinemas showing Western and Imax films is further up the street, with a shopping center filled with Western fast food restaurants. All of this lives peacefully side by side.

I'm far from the center of the tourist sections of Bangkok as well as the older parts of the city. I've not found a wat (temple) in my wanderings yet, or a place to get a good massage (though I've ventured downtown to other districts to have my first experience of Thai massage). I've been surprised at how few monks I've seen on the streets. I suspect it's a bit like living in Queens in NY (as I do) -- life as many New Yorkers live it, but not necessarily what people think of when they imagine Bangkok. But it's home for the next couple of months, and I'm learning more about its changing faces every day.

TTAG: The Work

It's been less than a week since I began my work with TTAG. I've spent much of the last few days immersing myself in the organization's background -- reading funding proposals, talking with Karyn and Ott (the co-founders) about organizational challenges, observing a recently formed Community Advisory Group at HIV-NAT at the Thai Red Cross, whose purpose is to provide a voice for community representatives and advocates in the decision-making regarding clinical trials and other research taking place in Thailand. While there are subtle cultural differences in the way that work takes place, I'm more impressed by how universal the challenges are of making a place for the community at the decision-making tables. The advocates here are seasoned, savvy, and well connected internationally, so even the alphabet soup of acronyms of partner organizations are familiar -- GMHC, Doctors without Borders, USAID, CDC, WHO, etc. There seems more at stake when you're talking about clinical trials being conducted in your country by US pharmaceutical companies without guarantees that the Thai government will have the right to produce the drugs for their own markets. Yet much of the dialogue and context in which TTAG operates is not dramatically different from that of US advocates operating within the context of the Bush Administration.

TTAG is, itself, an interesting marriage of East and West -- Karyn, a bilingual international human rights advocate from New York working side by side with Ott, an HIV positive, former IV drug user, and community activist. They've used an incredibly effective strategy of building international networks to move both the local policy agenda, as well as bring the voice of PLWHA to the international policy conversations. The international nature of their work means that they work literally day and night -- on the phone with the US, Australia, Canada and Europe in the early morning and late at night, in meetings and doing their work here in Thailand the rest of the time. Their powerful alliance has brought them much acclaim and attention; critical for giving their work visibility but also becoming a challenge to manage. Requests for visits, articles and speeches come in every day, while the work on the ground here in Thailand still requires their political acumen to move forward. The small staff needs much support, and Ott and Karyn need help figuring out how to create an organization that doesn't demand so much of them. It is, for this, Ott says, that I am here, to find the miracle that will allow him to attend to the international work and not worry that things aren't going well in their local peer leadership and community building efforts. To find a way that the work at which he and Karyn have been so successful will not compromise their health. We've joked that my MOU with TTAG didn't promise miracles. So now begin the hard conversations to see what can be done, little by little, to build an organization that is not so dependent on its founders, and whose work can flourish and be sustained.

First Impressions

This morning, the bowls I purchased in the market were wrapped in a school child's corrected homework assignment. Yesterday, downtown, we navigated a five floor electronics mall with American music blaring and women dressed in chiffon hawking high definition television sets. We stopped to make merit at one of Bangkok's most famous shrines, where tourists watch from the cafe high above through the windows of the Hyatt Hotel. This is the Bangkok where I have landed. Later today, I will join Karyn, my colleague from TTAG, to have lunch with a international women's advocate from Washington, and perhaps stop by the demonstrations against the Prime Minister, which are expected to draw 200,000 (though perhaps less, for with the furor rising about the financial deals he made to bring wealth to his family, just yesterday, he agreed to call new elections.)

I am learning the Skytrain system, one of the only ways to cut through the choking traffic which everyone told me about, but which is truly indescribable. I'm tracing the water taxi routes from the trains to the places I want to go -- anything to stay out of the traffic. Yet, there are large American cars everywhere -- down tiny back alleyways, parked in the markets -- a symbol of an increasingly affluent (or debt ridden, depending on who you ask) middle class.

I am wandering the wonderful market down the block from my apartment, and trying to make informed decisions about what is safe to eat and what is not. There is food everywhere -- literally everywhere -- with vendors set up along every street and roadway. What costs 60 baht ($1.50) in the air-conditioned restaurant might cost 30 baht on the street -- and everyone, including Westerners seems to eat from almost everywhere. Karyn is educating me on her strategy -- foods boiled and kept on ice okay, foods out in the 100 degree heat without any refrigeration probably not.

And so I've spent my first two days in Bangkok -- a place which, on first impressions, I already love.

It's a Small World After All

I've not left New York yet, but already I've met all kinds of people willing to share their expertise to assist me in my assignment at Thai AIDS Treatment Action Group (TTAG). Everyone from casual acquaintances to people who I've known for many years have recommended people to contact. I am amazed at how many people have a connection to people who have lived or worked in Thailand or Southeast Asia. This week, an e-mail from a local harm reduction expert linked me to a man in Australia who has spent years setting up programs in Asia. A chance encounter with a friend at the Institute for Healthcare Improvement last spring has reaped wonderful connections to the AIDS Institute here in New York, and to resources to share with those overseas. (to say nothing of great restaurant recommendations!!) A leadership development training program for PLWHA I was researching at TTAG's request circled me back to people I've known for many years.

There are many things striking about this experience. The world is infinitely smaller, yes, but there's a certain irony that it's taken a volunteer assignment in Thailand for me to discover the resources in my professional network here in New York. A reflection of how busy we've all become? Or how comparmentalized? I've been out of HIV prevention work for nearly fifteen years, and while I've been lucky to have broad networks, they've been outside of the world of HIV prevention. That it's taken new relationships with people on the other side of the world to re-connect these ties is also, however, a reflection of the global ties that now exist to disseminate knowledge, and how powerful they have become. It's clear already that my experience in Thailand will build as many new relationships here at home, as it will overseas. Now that's a small world!!