We started the day at a substance abuse lecture – the professors at this site visited us with beautiful jasmine flower garlands before we entered a I guess the Thai hospitality never ceases! The healthcare professionals leading this substance abuse program focus on improving health for the target population by prioritizing the holistic care of the patients. This effort involves the work of collaborative teams that are responsible for eight villages in a sub-district, which encompasses three primary schools, two secondary schools, and one technical college. Common diagnoses include cardiac disease, hypertension, lung disease, and gout. The shift in health habits such as increased driving has increased the incidence of some of these diseases, but substance abuse is one of the most prevalent health problems. It influences other health conditions like mental illness or suicidal ideation. Alcohol dependence is diagnosed based on an audit created by the World Health Organization, which asks questions about substance use, drinking frequency, and amount consumed per week; these responses are converted to a number score. A score over 20 indicates chronic alcohol use e.g. drinking every day in large quantities. There is a five week, two-step assistive program focused on reducing alcohol consumption and ultimately stopping it, and the program begins after a patient leaves the hospital. One of the criteria for the program is voluntary participation by the patient and consent from the family to support the individual, particularly with symptom management. Each person can set their own goal for reduction, which gives them greater flexibility to break it down into feasible steps. Participants develop skills like adaptive thinking or alcohol refusal – for example, they practice reciting specific reasons that they cannot drink e.g. “I cannot drink alcohol because of my medications.” By going through this roleplay with their nurses, patients know what to say when they’re offered. The program focuses on mobilizing the whole community in helping the 22 patients with alcohol dependence (an audit score over 20) meet their goals. This way, they don’t have to overcome their addiction on their own. In America, a lot of people face this issue on their own, and there’s a common image of alcoholics who drink in solitude. In Thailand, substance abuse is a public issue, and the solution comes from this shared support system. In the context of this program, the goal is reduce someone’s status as alcohol dependence to a lower score audit. I think this way is more effective because it parallels harm reduction programs in the U.S. that invite people to drink in a less harmful way, not just quit cold turkey and avoid sharing their struggle with others. One of the program participants commented that they tried to quit altogether on their own but experienced harsh withdrawal symptoms; switching the focus to reduction seems to be a more sustainable approach for him.
During the lecture, they brought in two people who had previously been diagnosed with alcohol dependence disorder but overcame it through participation in the program. One person said that he started drinking when he was a soldier, mostly in social situations since it was a societal norm. He was told that he was addicted and since then, he’s been working on reducing his consumption in an effort to quit, but he says he needs time. There are programs akin to Alcoholics Anonymous, but they are adapted to the predominantly Buddhist population in Thailand. Since we don’t have a national religion In America, it can be difficult to leverage common cultural values in a country that’s so diverse.
Both of the men were incredibly humble and stated that the only challenge to quitting alcohol is in your own head – there’s nothing difficult about the program itself. To keep going, they think of their loved ones who care for them and focus on prioritizing their own health. They voiced that their family and friends are supportive of their choice to quit, although some people still invite them to go out. Ultimately, people participate in this program for themselves and for the people who love them like their children. The presenters commented that the nurses who perform home visits treat patients like their family and prioritize their well-being; in exchange for this care, some patients may feel a desire to stop drinking as a way to pay back the good they’re receiving. Some of the nurses may contact their employers to solicit their support. I guess the personal stakes are higher if there’s a person checking up on you and inquiring about a condition that becomes a significant part, maybe even a struggle, of your everyday life. I wonder if this is more powerful than a desire to quit for yourself. Maybe it gives you something to live for, knowing that someone wants you to succeed and keeps supporting you during those tough days. There are also programs specifically for relapse patients. They distribute booklets for the patients and personnel as well as a notebook that the nurses can bring to each visit. Other support mechanisms include medication support, crisis management, and counseling. The staff also supports people in their holistic well-being by helping them find job opportunities or housing. I thought back to Jason Kilmer’s lecture on Alcohol and Other Drugs during resident adviser training. These programs involve reduction and prevention, but some of the same principles apply.
Afterward, we went to visit a few patient homes to hear from patients firsthand. Each patient discussed their experience in the program and how their family members have responded. It became clear that alcohol dependence isn’t an individual problem – it bleeds into every other aspect of life from home to work; one person’s daughter talked about how her father used to drink alcohol like water. She responded by ignoring him because she was so frustrated and angry, and all he offered were empty promises to quit that weren’t fulfilled. When she got into a prestigious school, the father wanted to stop drinking as a present to her but he couldn’t do it. We could tell that there was some resentment and bitterness from the daughter, but she must have some hope because she’s still supporting him despite it all. She hasn’t give up on him even though he’s been drinking her whole life, but I’m happy to report that he’s been sober for the last six months. He believes he can keep it up and attributes his current success to the high quality care of the nurses. So, what happens to the battle of the bottle that feels like it can never be won? Maybe there’s a chance here. The nurses emphasized that the patient believed in himself, but he needed his family to believe in him too. I hope with all my being that he’ll be able to keep to up. Additionally, when patients relapse, they are more likely to overcome their addiction with each successive effort. So even if he falls down seven times, he’ll stand up and be stronger than before. We visited another person who focused on harm reduction, and he even brought out his piggy bank where he kept the money he saved from purchasing less alcohol.
For lunch, we had our very first round of khao soi, a noodle and coconut curry dish that’s a popular street dish in Northern Thailand. The dish was pretty spicy but mostly flavorful, probably the most depth of flavor I’ve had in a noodle dish thus far. The shop was owned by a current program participant who is working on reducing his own alcohol consumption and ultimately quitting. It’s cool to see that he is making a life for himself and sharing the food of his people with travelers like us – his struggle with addiction doesn’t define him.
Post-lunch, we headed to the Center for Thai Traditional and Complementary Medicine (TTCM), which offers both traditional Thai medicine and modern medicine to approximately 60 to 70 patients a day. Modern medicine includes general health checks-ups whereas Thai medicine includes alternative treatment options like massages with herbal compression treatment, all of which are supported by the Thai health policy. Traditional Chinese medicine encompasses acupuncture, cupping, and Chinese herbal medicine, and we saw a few demos of each! As a non-profit center, the TTCM provides free services for monks every Monday, Wednesday, and Friday. The Center also conducts research about the efficacy of its services, and they also offer short course training as part of their teaching and learning arm. We toured the pristine white grounds and each wing of the Center as well as the herb garden used to grow ingredients for medicine and treatments sold in the gift shop or used on patients. I love the concept of integrated medicine because it leverages the benefits of each kind of therapy to help patients live their best lives. Some other people noted that some insurance plans in America cover these kinds of treatments, and some had even help their parents with acupuncture. I’ve only gotten a massage once, and I’ll admit that it was pretty relaxing so I’d be open to trying something like that more regularly! I’ve always believed that people should do what’s best for them, and I’m glad that the Thai health system supports this as well with universal healthcare coverage.
After returning to the hotel, I wrote for a bit before heading out for the Thai cooking class at Madam Thai Cookery School, which was just around the corner from our hotel. The owner and instructor, affectionately known as Madam, owned a Thai restaurant for 22 years before retiring. She said that she missed cooking so she started offering this cooking class for people around the world to come in and learn her secrets, and she’s been fearlessly teaching people how to prepare five course Thai meals for the last two years – and she’s really good at it! I’m still trying to find a passion like that – a job that I’m genuinely excited to clock in for every day. I think human centered design and engineering might be the perfect combination of technical communication, robust coding and website design skills, and user-centered work that I want in my future career.
Our menu selection for the evening included papaya salad, pad Thai (hopefully that’s not a surprise at this point), massaman curry (per our teacher’s recommendation that this was the most complicated curry option), chicken and coconut milk soup, and sticky rice with mangos for dessert (even the temptation of a dessert couldn’t get me to choose the banana dessert options). When we entered the shop, we were immediately greeted with warm smiles, and the ingredients to prepare our first course were already set up at a long table. We all put on aprons and marched to our stations, which included a cutting board, knife, and a mortar and pestle – when in Thailand, do as the Thai do! Before we started slicing and dicing anything, the chef introduced us to all the herbs and spices we’d be working with. We started by smelling everything from lemongrass and cilantro to three different types of ginger. I learned that kaffir limes have 2 leaves that are attached at each stem, but regular limes just have one eat – who knows, maybe this will be a good fun fact for dinner parties or my next trip to the grocery store when I want to replicate these dishes. She let us take in the aroma of every item and explained its use in Thai cooking; I felt like she was my mother, trying to pass on the legacy of her food and culture. Although my mother is one of the most talented cooks I know – you haven’t had dessert until your tried her pumpkin slice cake with Ghirardelli white chocolate glaze – I never took the time to learn the tricks of her trade, and I regret that now. I’ll never be able to perfectly recreate her famous barley soup or veggie stir fry, but I’m going to start trying this year. Also, Rataouille taught me that anyone can cook so I’ll hold on to that advice. The stakes are even higher for me because I’ll have to cook for myself for the first time ever since I’m no longer leaning in a free meal plan or leftovers from my mother’s bulk cooking. But Madam made cooking seem pretty straightforward, maybe even simple as long as you use high quality ingredients and do your prep in advance. She always took the time to praise us when we did well and was actively involved in the cooking process by providing tips about how to break a garlic bundle or smash and twist the ingredients of curry. For the first dish, we used our mortar and pestle to mash up a medley of papaya, carrots, tomatoes, chilis, and peanuts. Although I’m not usually a fan of the dish, this one was the perfect marriage of salty, sour, spicy, and sweet, which are all flavor elements of a successful Thai dish. I know it’s true that food tastes better when you’re hungry (years of fasting for Ramadan taught me that much), but that must be compounded when you prepare food with your own hands (and on your own time). I’ve never made something from scratch before, no exaggeration, and being able to use fresh ingredients and mix it all myself made the appetizer course significantly more rewarding and delicious – I think my apartmentmates are in for a treat when I get back!
We moved on to Pad Thai and ran through the Chopped 101 skill set like crushing garlic, julienning the tofu and green onion, and preparing the sauce with coconut sugar, hoisin, and soy sauce. We went on to prepare every course, and we were able to evoke the depth of flavors found at restaurants like Indochine and Thaiger Room. It was really empowering to get behind a wok and actually cook food for myself, and I think I’m ready to take it on as a regularly during junior year. My favorite part of the meal was the mango sticky rice, but mostly the mango portion. My dad always gets honey mangos shipped from Toronto and Pakistan and eats them by the pound, and this dessert reminded me of him because I always ask him to cut some for me when I’m home . These mangos were more tart than sweet (which is the way I prefer them), and the smell of the turmeric powder used for the rice reminded me of the smell of my grandma’s home. It’s always nice when I get glimpses of home and my family while I’m here. And to top it off, we stopped at a Starbucks on our way back, and I walked around the establishment and pretended that I was within walking distance of the Space Needle and my favorite creperie in Pike Place Market. The bakery section offered some tried and true items like blueberry muffins and croissants as well as Thailand specialties like green tea cake with red bean paste as well as chocolate waffles. It was nice to see a piece of my favorite city and even if I’m only one week from going back, I think about Seattle every day – I guess growing up in one state for 19 years has finally caught up with me. We bought some elephant pants on the way home, and I’m excited to rock them during the rest of the trip and back in the states. And now, I’m back in the hotel and I’m getting ready for a day of nature exploring in Chiang Mai. Stay tuned for our overnight adventure in the Thai wilderness!