Reentry

One of the most dangerous, breathtaking moments of space flight is the process of reentry, or the moment a spacecraft passes back into Earth’s atmosphere and descends back down towards the planet’s surface. The process of reentry is highly controlled, anticipated, and has many chances for everything to go wrong. Depending on the type of spacecraft, the process may have different, recognizable steps and stages, such as the fireball of ablative material covering the command module of Apollo spacecraft or the balloon of the space shuttle’s parachutes, but the Icarus-like decent of space explorers always ends in one of two ways: everyone and everything burning up and dying or a ground crew pulling out and tending to the crew of astronauts who, upon reencounter with the pull of gravity, look more like a jumbled mass of wet noodles.

The past few years have felt to me like some sort of marathon space flight, trying to learn and experience as much as I possibly can while hurtling at approximately 17,500 miles an hour in orbit around my friends and family, my professors and academic requirements, and numerous clinical environments, absorbing, analyzing, and reflecting on new information and experiences while simultaneously incorporating them into clinical care. From this wet noodle vantage point, I feel as if I discovered and entered the field of child life about a week ago, blasting off into academia and clinical internships in New York City, passing exams, and then practicing as a certified child life specialist in Laos all within a single breath before rapidly descending back in a giant burst of flames. As I attempt to readjust to the pull of gravity here in America, one thing is abundantly certain to me – I need to go back out there.

Upon the conclusion of the first American spacewalk on June 3^rd, 1965, Gemini 4 astronauts James McDivitt and Ed White had a hilarious exchange that has thankfully been well documented in the annals of history.

“McDivitt: They want you to come back in now.

White (laughing): I’m not coming in… This is fun.

McDivitt: Come on.

White: Hate to come back to you, but I’m coming.

McDivitt: Okay, come in then.

White: Aren’t you going to hold my hand?

McDivitt: Ed, come on in here… Come on. Let’s get back in here before it gets dark.

White: I’m coming back in… and it’s the saddest moment of my life.”

This remarkable snippet of dialogue between the Gemini 4 commander and his crewmember who wants nothing more than to continue to explore the vastness of space is as humorous as it is poignant. Sitting here on a couch in America, I commiserate both with the patient commander McDivitt and with White. I want nothing more than to be practicing back in Laos, but I also understand the need to follow through with the various responsibilities that brought me back to the states. I have spent the past week since I touched down at JFK searching for grants, applying to jobs, and hatching ideas that could launch me back to LFHC. As I adjust to the time change, shake off the jetlag, and wade back through the emails and detritus of belongings I left in the states before my journey to Laos, I am caught up both in my longing to return and my desire to somehow make a living out of this itinerant child life specialist practice. I am not yet certain of how I will make the journey back nor of how to sustain such a CCLS practice, but I am certain that the work I had the honor of participating in during my time at LFHC was more impactful and transformative than anything else I have ever done in my life and returning to a stereotypical, Western clinical environment seems like falling far short of any CCLS potential that I have.

Perhaps it is just the nagging effects of jetlag, perhaps it is nostalgia for the people, places, and experiences of the past three months, or perhaps it is today’s anniversary which steels in me a renewed urgency to live a life that I am proud of and which makes a positive, sustainable impact in the lives of those around me. As I find my way back from this wet noodle state and search for a way to head back out there, I plan on continuing this blog and on compiling a larger work of reflection on these past three months in the hope that, in sharing stories and reflections, I can expand upon the collective knowledge of what a child life specialist is, what it takes to become one, and what practice may look like in very different parts of the world. I thank you, readers, for coming along for the ride so far. It’s not over yet.

 

For more information about the Gemini 4 spacewalk: http://time.com/3739536/americas-first-space-walk-edward-white-makes-history-june-1965/

On Leaving a Mark

I’m writing this post to procrastinate packing away the last of my belongings, only partly because they’re still wet from the rain. According to the ticket I have, tomorrow I will be on a plane leaving Laos, the hospital, and the community of people I have come to love so deeply. It feels so terribly wrong to be leaving, but, as I sit and reflect upon my time here, I know that I have made an impact and will be leaving a legacy behind.

A couple of weekends ago, I took a Hmong batik class with some friends from the hospital. We sat in a dusty room attached to a Hmong batik store, sweating together around a cauldron of hot wax for most of a morning. We took turns dipping metal stamps into the molten wax, shaking the extra wax from the stamps while trying not to fling any onto one another, and then pressing the stamps onto our pillowcase sized pieces of fabric. None of us had ever done batik before. We were not entirely sure what we were doing. At times, we left too much wax on the stamps and the image pressed into the fabric upon the stamp’s removal would be more of a blob than a buffalo. At other times, we shook off too much or didn’t press hard enough and the resulting image was faint and equally unclear. For as many mistakes as we made, however, the finished pieces were beautiful, folksy, patterned depictions of many of the common icons of Laos. We left them in the giant vat of indigo to absorb the dye and picked them up at some point last week.

My batik piece is now packed away in my suitcase, but the final product is quite symbolic of my time here in more ways than the simple image. Where I had planned out my design as I went and printed the wax onto the fabric, there are off-white areas. Where there was no wax, the fabric absorbed the rich indigo, turning a dark navy blue. Not all of the stamped areas came through as planned, however. As mentioned above, there are the marks of mistakes, but there are also areas of the batik piece which looked promising in its initial wax stage, but that in the resulting final piece were too faint and now are barely visible, subtle ghosts of an image on the fabric. As I reflect on my time here in Laos, I am struck by the symbolism of the batik as far as what I leave behind as my legacy.

When I stumbled upon the advertisement for this volunteer child life position, I was drawn in by the sustainability of the hospital’s mission and keen to take part. The money I raised in the gofundme which made it possible for me to be here and for which I am so thankful supported not only me, but also the mission of the hospital to develop sustainable, high-quality pediatric healthcare infrastructure and empower the people of Laos to continue to provide care within a decade’s time. As I look back on where I was, where my child life colleague was, and what the psychosocial care of children and families was like here when I started, I am stunned by how much things have changed for the better. Members of the medical team advocate for comfort positioning and distract patients with their phones during procedures when child life is not available. Information is shared in ways that patients and families can understand. Members of the medical team make opportunities for play for patients, blowing bubbles and engaging with toys at the bedside. This past week, two nurses gave a presentation on supporting patients and families at the time of death and they not only discussed emotional support, but also accurately broke down patient needs based on developmental levels. I am more proud of my child life colleague and the growth he has made than I have words to say. There have even been physical changes to the hospital itself with the implementation of a bereavement supply cabinet and a toy cabinet down in the inpatient unit which is also accessible to ED.

Like my batik, I know that some of the changes that I put into play will not stick. Some ideas were too grand and are more like the blob buffalos than they are sustainable, others more like the ghost images fading into the background. Yet, I know that a great deal of the work I have put into the hospital, the staff, the families, and the children during my time will continue to reap positive benefits in my absence. I am terribly sad to go, but I am so moved by the impact I can see in those around me and I know that for every tiny change I helped to make in the hospital community, the hospital community here has left giant changes in how I practice child life, what I take for granted, and how I envision my practice going forward. I am inconsolable about leaving, but I know that the sooner I go, the sooner I can come back.

Thank you so very much to everyone who has made this journey financially possible. I am so grateful for this experience. When I have more time and distance, I intend to write a longer piece with more stories and reflections. For now, this last blog post will have to suffice.

Farewell, Laos.

Farewell, hospital.

Farewell, friends.

See you stateside in a few days.

A Part of the Team

Last night, I ended what has been a very intense and difficult week playing soccer with the intramural women’s soccer team. Despite the fact that running is a big coping mechanism of mine, I am not a very sporty person. I do not follow any sports teams, I do not watch any form of sportsball, and my general understanding of how to play soccer does not extend beyond kicking the ball with your feet into the goal without using your hands. Yet, as I squinted at the blurry people passing the ball, having removed my glasses lest something happened to them, and joined in the joyful fray, I could not help but be caught up in the similarities between playing on the team and taking part in the week’s intensity as a member of the interdisciplinary medical team.

Life here in Laos is difficult at any time of the year, but rainy season tends to magnify the difficulty a thousandfold. Access to care, which at the easiest can be up to 24 hours of travel for some families, becomes nearly impossible when the rain drives rivers up onto banks, swamps roads in mud, and makes bridges disappear. The effects of the rain have been apparent throughout the season, with families unable to make follow up appointments or arriving with nightmarish tales of spending days with compound fractures, seizures, or meningitis before being able to travel to care, but the results of the rainy season really peaked this past week. Over the course of four days, we had approximately 9 or 10 patients arrive and then pass away in the ED from illnesses which had progressed to the point that there was little the medical team could do to save the child. At some point, I stopped counting. In order to preserve our sanity and continue to be present with each and every grieving family, it was essential for every member of the interdisciplinary medical team to function exactly within their role, moving from bed to bed and code to code, acknowledging and making space for one another between compressions and handprints.

A statement I heard often throughout the intense week from many different members of the medical team was, “At this point, [the patient] would have died in any hospital in any part of the world.” It was an interesting variation on the typical, “there’s nothing more we can do”, but it sounded wrong to me for reasons I couldn’t pinpoint at the time. As I embraced weeping mothers, fathers, and grandmothers who clung to me so tightly that I could smell the lingering scent of the morning’s cooking fire in their hair, waved away eager flies who weren’t fooled by the oxygen masks we placed over the faces of newly dead children to sneak them back into their villages for burial, offered shrouds and hats and burial clothes, and made careful handprints and footprints of so many sizes and colors, I was continually struck by how horrible and unique it all was. Yes, the patients all arrived in a state where there was little if anything anyone could do with any amount of resources in any hospital setting, but in other parts of the world, they would not have progressed that far before finding care. Most of the time in places like America, diarrhea is not a death sentence.

This week was unspeakably tragic and as much as it drove home the privilege of growing up in a country where I could consistently access care no matter the weather, the repetition of resuscitation attempt after resuscitation attempt on patient after patient after patient drilled into each and every one of us the impact of our roles. As I stood in a quiet moment with the body of a dead 8-year-old boy, waving away the flies and rubbing my thumb over his stiffening shoulder to give the fleeting impression of life to patient and family passersby through the ED and lend some measure of comfort through vigil while his family went to arrange transportation home, I was taken by how important each member of the interdisciplinary medical team was in such moments of extreme, repetitious tragedy. Just like the blurry, joyful women sprinting and kicking after a ball on a dusky Friday night, changing direction back and forth or waiting for their moment in the goal to dive, block, and save, the frenzy of the resuscitations, the sober calm of conversations about withdrawing support, the heartbreaking spreading of paint over palms and soles, and the gutwrenching wailing of the families of the newly deceased paints a similar, though unspeakably more tragic picture. In any environment, be it a field or a death, each of us has a part to play. While this week has been so very difficult, I am honored to have been a part of the interdisciplinary medical team and to have been able to lend some small comfort during the hardest of hard times.

On the Unity of the Body

I must start this post with an apology. As the days I have here in Laos continue to dwindle, I find myself neglecting this blog more and more in an effort to soak up as much time experiencing life with the community here that I have come to love so deeply. I do not know how many more posts I will write in the 9 days I have left, but I intend to reflect more fully on my experiences when I am back in America and have more distance and time to write something which adequately encompasses my time in Laos. Today, however, was full of experiences which speak to so much of what I have come to learn and love about Laos, its culture, its people, and the hospital here. This Tuesday started in the operating room (here called the operating theatre) and ended in the morgue, stretching my child life coworker and me to fill all the roles within the Laos child life scope of practice.

Before my coworker and I had even changed from our biking clothes into our scrubs this morning, we were already being briefed about a case which had come in overnight. A 5-year-old boy had been brought in by his family following some sort of explosive accident. The story of the accident still remains mostly unclear. As much as the parents could tell the medical team, their son had gone out to play with a group of friends and had returned with his hand in shreds, talking about bananas. When a wider group of family members arrived later in the day having spoken to other children from the village, a story solidified that someone had buried some sort of explosive in the forest in order to catch a wild pig and had left a banana on top as bait. The patient had seen the banana, grabbed for it, and the trap had exploded, injuring his hand. Descriptions of gunpowder, bomb powder from a UXO, or a UXO continued to color the story as the day progressed, but as far as we were concerned from a child life perspective, what mattered most was preparing the child and family for what the medical team anticipated would be a partial if not complete amputation of his dominant hand.

We found the child and family waiting at the bedside, parents silently morose having heard the plan from the medical team the night before and the child, who as far as we knew had not been spoken to in detail, crying quietly. We introduced ourselves and built a rapport with the family and the child in broken Khmu and Lao before grabbing a fluent Khmu speaking staff member to effectively translate the OT prep and our discussion of his hand. While I am not entirely sure what words were said as I do not speak either of those languages, I helped to prompt my coworker’s discussion of amputation and guide his understanding of magical thinking, making sure that the patient did not think that the surgery was punishment or that he was to blame for the accident. He walked himself into the operating theater, happily distracted by an episode of Shaun the Sheep.

While I had never prepared a child for an amputation in the states, I expect that familial support for amputation here in Laos differs from what might be expected in most ORs in America. In the three main cultures of Laos, there is a great deal of significance placed on the unity of the body. I do not know enough about the details of this aspect of culture to write about it at length, but the unity of the body mentality results in many cultural practices and some medical frustrations. When babies are born, placentas are extremely important and are buried and treated in culturally specific ways as I have been told it is believed by some that when a person passes away, the person and their placenta are reunited. Unity of the body also results in difficulty in people donating blood in this part of the world and organ donation is not something that is even considered, both due to culture and to lack of medical infrastructure. As it severs a part of the body and breaks some of that unity, amputation is quite a culturally significant surgery.

In a quieter moment, while waiting for OT, my coworker and I took the patient’s father aside and inquired about the family’s cultural beliefs and what he would like to have happen to the part of his son’s hand that could not be saved. The father requested to take it home for burial and so began an aspect of child life care which I believe is quite specific to this part of the world. While juggling other patient needs and developmental clinic, I looped back into the observational area of the OT, checking in on the surgery and verifying with the excellent OT staff that the removed digits and partial palm were preserved in a well-sealed, labeled specimen container. When the surgery was complete and I brought the father back to recovery, I observed the handover of the amputated material and then filled in the rest of the medical team on what was in the specimen container and how it was labeled in case it became somehow separated from the family at the bedside.

Keeping the body and the family together is a significant aspect of culture here and greatly impacts patient and family coping. While facilitating body part collection and preservation is not necessarily something which normally falls within the scope of child life practice, providing bereavement support is an aspect of child life care in all parts of the world. My coworker and I became enwrapped in developmental clinic following the end of the amputation surgery and, as we were not on the floor, we were not notified of the death until much later after it had happened. A school-aged child had been very, very ill for many days and arrived too sick to be helped. He was accompanied by his older brother, a young adult. The family lived up by the border to Vietnam, a 6-7 hour journey from the hospital. Though the medical team did all they could, he passed away before the family could be present with the patient and the older brother.

At the end of developmental clinic, my child life coworker and I were informed of the patient’s passing. We spent a bewildering stretch of time trying to track down the body and the brother who we knew had to be somewhere on the hospital grounds waiting for the rest of their family to arrive. The body was not as hard to find given that it was in the morgue, but it took quite a while to find the brother. We sat with him and talked with him for a while, offering condolences, support, and postmortem prints. He chose a rich, royal blue as the paint color and walked with us to the morgue, unwrapping his brother’s shroud to find his feet and spreading the paint neatly over the soles to make prints. We laminated the prints and helped him find a place he felt comfortable waiting for the rest of his family, holding tight to the small piece of his brother we could give back to him.

It has been a fascinating journey to be part of the child life team here in Laos and to learn so much about the cultures of the children, family, and staff here. As I prepare for the end of my time and my return to my home country, I find the topic of the unity of the body incredibly poignant. The body of staff who support patients, families, and one another, who heal and educate here in Laos is everchanging. Lao staff remains mostly constant, but the international staff of volunteers is in constant flux. Yet, despite the incredibly high turnover, there is a continual unity in the body of staff. Whether it is through the shared mission to create sustainable, pediatric healthcare infrastructure, through the unending drive to heal and overcome obstacles, or through the ceaseless compassionate energy, the body of Lao and international staff is one unified force. While my time here may be coming to an end and I may be severing myself from the unified body of LFHC, I know that the work here will continue and what I have put in during my time will live on here as what I have been given will live on wherever I go next. I am so honored to have been able to be one small part of the whole.

So Many Stories: Information, Advocacy, and Child Life Scope of Practice

The way that advocacy takes place and what needs to be advocated for is dynamic and constantly changing in any setting, but here in the hospital in Laos, the main way I find myself filling the advocate role of child life is through information dissemination.

Communicating information happens in many forms here in the hospital in Laos. There are lime green, paper-filled binders at the foot of patients’ beds where ongoing chart notes are kept. There are little, pastel green books that caregivers bring with them to the hospital that function as medical records, holding information in a mixture of scrawled English and Lao on the last weights, heights, diagnoses, and treatments the child has had whenever the caregiver remembered to bring the book with them to the hospital. There are two handover documents, one for nursing and one for doctors, where the medical team keeps an updated report of suspected or confirmed diagnoses, treatment plans, and pertinent information on inpatient children. There is also an electronic medical record where clinicians document care. Despite the abundance of communication and documentation systems, it is often the case that there are a multitude of different stories and understandings about plans of patient care or a family’s plan and understanding of the medical team, especially when cases are complicated or there is a change to the plan of care. There are usually at least a handful of moments throughout the day where I find myself physically circling through the patient care areas, lapping the hospital as I loop in members of the medical staff in order to find out what is really going on and establish a mutual understanding amongst the patient, family, and staff.

Today is Tuesday, which is usually a developmental clinic day, but as the river is so high from rainy season, many of the patients and families who were scheduled to come could not make the journey to the hospital and my child life coworker and I divided ourselves between the clinic and inpatient/outpatient areas. It was while we were passing between these two clinical areas that we learned what was at first a very disturbing story. A flustered doctor in training approached us in the stairwell and informed us that the family of one of the NICU babies had told staff that they were leaving and they were not going to take the baby with them. The doctor continued to say that the family had asked to take the baby at first, but given that the baby has an omphalocele and is in need of a lot of care, discharging the infant would essentially mean sending it home to die. She stated that she had explained this to the family and that the family had agreed to leave the baby at the hospital, but that it was her understanding that they were abandoning the child and were never going to come back, so could we please go talk to them?

One of my favorite TEDx Talks is The Danger of a Single Story by Chimamanda Ngozi Adichie. In a blog post about advocacy through sharing information in order to find the truth in a healthcare environment, a TEDx Talk called The Danger of a Single Story may sound like something that goes against my point. Rather, Chimamanda Ngozi Adichie’s talk is all about reserving judgment based on bias and limited information, of keeping an open mind to the differences and similarities in the lived experiences of those around us. I wish I could say that the need to keep an open mind was the first thing that I recognized as I heard the doctor’s request. In reality, my heart sank to the pit of my stomach and I watched my coworker’s face turn to stone. We already have one abandoned baby in the NICU who tugs all our heartstrings and, as a parent, my coworker perhaps has even stronger feelings than myself about abandoning a child. By the time we reached the bottom of the stairs, however, I had pulled myself together. The rest of the walk to the NICU, my coworker and I discussed the fact that we both knew that such a case was liable to bring up big emotions for both of us, but that the best tactic was to walk up to the parents and feign absolute obliviousness, giving them the chance to share their side of the situation and provide support in facilitating communication between the family and the medical team.

We found the parents sitting outside on a straw mat. It was obvious from her face that mom had recently been crying and both of them did not look happy. We sat down next to them on the ground asked simple questions that did not directly touch on the topic at hand. We commented on how long they had been in the NICU with their son, validated that it was not easy to be here day after day, checked in about their food supply, whether they were sleeping, and how they were feeling. After a few minutes of this type of conversation, dad began to open up. He stated that they would be leaving that afternoon. We asked why. The answer to their question made me glad that we had taken the time to acknowledge the danger of a single story and keep an open mind.

In contrast to the story we had heard in the stairwell, the parents shared that they were not, in fact, abandoning their child, but that mom was feeling quite unwell and unhappy and that, culturally, when a woman felt as she did after childbirth, it was customary in their traditions for her to return home to their village where she could be cared for by her mother and their family, drink and eat specific foods, and have specific ceremonies performed. As they only lived two hours away, they were planning to have her pump milk and have dad bring it in each day on his motorbike. We continued to talk for a while about the specifics, offering to take photos of baby to send home with dad so that mom could continue to feel a part of his care. Mom smiled and began to cry again, nodding her head and putting her hands together in thanks. We concluded the conversation and went back to do another lap of the hospital, filling everyone in on what was actually happening, why, how the family was planning on making it all work, and what we were planning on doing to support them.

Here in Laos, it seems there are always so many stories to every patient, family, and plan of care. What I find so important, what encapsulates the child life role of advocate in this setting, and what defines the child life scope of practice when it comes to information dissemination is distilling the multitude of stories to find the humanity and working to have the human factor recognized, validated, and supported. I have learned so much about the impact of the truth in the clinical environment here in Laos and I look forward to carrying forth this aspect of advocacy into other future environments.

 

 

A link to the mentioned TEDx Talk, The Danger of a Single Story by Chimamanda Ngozi Adichie – https://www.ted.com/talks/chimamanda_adichie_the_danger_of_a_single_story/transcript?language=en

On Change, Culture, and Tradition

As my time here in Laos approaches its conclusion, I find myself continually struck by how much things change and how much things stay the same, both inside and outside of the hospital setting. There are aspects of hospital life and Luang Prabang life that are still exactly the same as when I first arrived: the drum beats each morning at 5:30am to signal a call to almsgiving, the monks are chanting in the temple and older and middle-aged women dance for exercise in the schoolyard near my guesthouse every evening at 6:30pm, the fruit, vegetable, sandwich, and meat stalls are always stocked along the roadsides, the stray dogs and cats are always looking for food, the motorbikes, bicycles, and trucks are always weaving around each other and the potholes at a speed of 20 miles per hour or less, there is always a constant flow of patients, families, and staff coming in and out of the hospital, grand rounds are Monday morning, developmental clinic is on Tuesdays, Thalassemia clinic happens on Wednesdays and Thursdays, and the staff meeting is on Friday. This past week, I have neglected writing this blog, wrapped up in tying up the loose ends of projects I have begun during my time here and in trying to bid farewell to other volunteers whose time has ended or will end in the next few days and weeks. As I anticipate my own farewells, I find myself reflecting on the unique aspects of life and of volunteering here.

The role of culture and tradition and the acceptance of cultural practices within the hospital setting has been an aspect of volunteering in Laos that I have treasured. From unknown substances lurking beneath beds in bowls, knives under mattresses in the NICU to protect newborns’ souls from dabs (evil spirits who would steal the soul away), black or brown pigment on the soles of patients’ feet and Baci strings wrapped around their wrists, to sacrificed mice in bags on the edge of a crib and tales of sacrificed chickens in the street outside, there is a recognition and validation of the practice of cultural traditions within this rather Western medical setting. Witnessing the effect on the patient and family of making space for cultural practice within the international medical team’s care planning has been a continually heartwarming and humbling part of volunteering in Laos.

For over a month, an adolescent girl was admitted to our inpatient unit with severe headaches, fever, and, as time went on, various other symptoms. Diagnosing her was a difficult task for both the Lao doctors in training and the extremely well experienced international doctors. For the first month, she passed from queried diagnosis to diagnosis: migraines, different types of meningitis, encephalitis, conversion disorder, and many others. The medical team tried countless medications, treatments, and tests, trying to alleviate her pain and identify her illness. It was difficult to find a way to reach her from a child life perspective, as her struggle with pain limited her desire to engage with anyone. The death of another patient she knew from school on the unit affected her strongly and it was her fear and grief from witnessing her passing that catalyzed her eventual opening up to my child life coworker and I. Even so, she frequently declined our bedside interactions and pain management and grief interventions. It wasn’t until about a month after she had been admitted that she was able to be diagnosed with an extremely rare form of meningitis, one which usually only affects HIV positive individuals despite her HIV negative condition. Treatment for this rare form of meningitis consisted of frequent lumbar punctures to remove cerebrospinal fluid and alleviate pressure on the brain as well as a very potent medication with side effects similar to chemotherapy. Given that we had to wait for such a medication to be flown in and it would be over a month of continuous, arduous inpatient treatment before she could be discharged on oral medications, the decision was made that she could be discharged for a few days to go home for culture.

When patients are discharged to go home for culture here in Laos, as far as my understanding goes, it usually means going home for a Baci ceremony. Baci ceremonies are celebrations of good luck (as in marriages, births, and entering monkhood), celebrations of recovery from an illness, or ceremonies seeking a cure from any ill health. As I have been told, they involve the whole family and community and, at some point during the ceremony, Baci strings are tied around the wrists of the honored individual in a spiritually significant manner. When Baci ceremonies take place to seek a cure for an illness, the Baci strings are meant to tether the individual’s soul and prevent their death. Some ceremonies take multiple days. When a patient is discharged for a Baci, they usually come back within a week. Some patients who are discharged for culture, however, do not come back.

The adolescent girl with the rare form of meningitis did come back. Her family rented a van of some sort and my child life coworker and I met them on the road outside the hospital ramp. While the days at home were good for her and for her family spiritually and her wrists and arms were tethered with Baci strings, she did not look well. Her uncle, my coworker, and I lifted her into a wheelchair and wheeled her straight into the ED, supporting her tall frame as she writhed in the wheelchair in pain and then nearly off of the ED bed, too disoriented and in too much pain to know where her body was and where the bed ended despite the bedrails. She was inpatient again for a few days and made a bit of a recovery, frequent lumbar punctures, pain medication, an NG tube, and medications helping her body while we waited for the more effective drugs to arrive. My coworker and I did a diagnostic teaching on cryptococcal meningitis, helping her to understand what was making her sick, what would make her better, and trying to come up with more coping techniques. She celebrated her birthday inpatient, getting a lovely pampering from the nursing staff and a full spa treatment including hair, nails, and a facemask. As the medication had still not arrived, the decision was made to let her return home for a second ceremony. The medication arrived at the hospital Wednesday night. Thursday afternoon, the hospital managed to make phone contact with the chief of her village only to learn that sometime between Wednesday night and Thursday morning, she had died in her sleep. While the inability to cure her and her unanticipated death are extremely tragic, the fact that she died at home and her family is thus able to practice their ideal death rituals and traditions free from any cultural taboos around dead body transport is comforting.

There are many things that are possible here in the hospital and many things that are not. For what resources are available, the care here is nothing short of miraculous. The nurses and doctors in training are excellent and the volunteer nurses and doctors are incredible teachers and resources.

This past Tuesday, I was taking a break from developmental clinic to eat lunch with coworkers on a bench in the stairwell above the entrance to the hospital when an ambulance pulled up. There is no real emergency medical response system here in Laos. The vehicles referred to as ambulances here are vans with questionable medical support equipment that are predominantly used to transfer patients between hospitals or to transport dead bodies back to villages when possible at exorbitant prices. Two teenage parents and a slightly older woman exited the vehicle and began to wander aimlessly around the foliage at the entrance, the woman holding a tiny bundle in her arms. My coworker and I stood up and went down the stairs to meet them and help them inside. As we approached, it was immediately apparent that the infant in the teenage mother’s arms was very blue. I smiled at her and said a quick “Sabaidee, this way” so as not to scare her as I put my arm around her shoulder and forcefully navigated the two of them into the ED, summoning help as we entered and stepping back to allow the medical team to descend and begin their lifesaving interventions. Despite the incredibly high-quality NICU care available here, I found myself back in the ED with the same parents and the same infant this past Friday evening, helping them to create painted handprints and footprints in the culturally significant, life-giving color green of their infant whose cardiac malformations were not anticipated to be survivable. The fact that the baby lived as long as she did and the space that is made for families in such a time is a testament to the level of care and compassion in this hospital.

Though many things change at the hospital, many things stay the same. There is a constant turnover of volunteers and the Lao staff are constantly learning and developing as clinicians. For every patient death, there are so very many who survive and thrive. As I sat in the back of the temple this evening, listening to the monks chanting and the rain falling outside, I found myself reflecting on how pervasive cultural traditions have been in my clinical experiences here in Laos. In the rituals, traditions, and taboos surrounding death and in the acute illnesses and injuries which prompt Baci ceremonies or animal sacrifice, cultural traditions stand out to my Western eye, but there is a place for culture and culture is woven into every part of the clinical and non-clinical environment here in the questions that are asked and the decisions that are made. As I prepare myself for the mental and physical transition back to the United States, I will continue to treasure and reflect upon the role of culture here in Laos and elsewhere in the world and how, though everything changes in our dynamic global environment, some traditions, some practices, and some places stay the same. I am so honored to have been a part of the sustainable, growing, adapting, empowering mission of the hospital as it works with, educates, and learns from this remarkable country and its rich cultural traditions.

Running in Rice Paddies: On Endurance and Ephemerality

All of a sudden, it’s August. I only have 26 more days here in Laos and I find myself beginning to both sentimentally treasure every second and become anxious about what might come next.

My senior year of college, I trained for and ran a full marathon. It was probably both the best time and the worst time to do it. My college campus had beautiful natural lands with long, looping trails where I could easily lap mile after mile early in the morning, sharing space with deer that watched me in anxious silence through the morning mist and twittering birds that took off the instant I got close, huffing and puffing along. As convenient as it was to have access to such incredible nature trails, the time I needed to spend on my studies conflicted with and took precedence over training. The week before the marathon, I did not take the best care of myself, did not get enough sleep, or eat properly as I was pulled in a million directions by assignments and responsibilities. The night before the marathon, I only slept about an hour, trapped in wakeful, anxious anticipation. I made another rookie mistake during the race and pushed myself too hard to keep a quicker pace than I should have in the beginning. I have a very clear memory of crossing the marker designating mile 14 and watching the pace group I had been running with slowly but surely getting farther and farther away from me despite exerting the same amount of effort. As they disappeared over the horizon, it became immediately clear to me that I was hitting a wall. The remaining 12.2 miles of the race were an exercise in misery and endurance while my body fought the motion I kept forcing it into and my mind was consumed with doubts and an unshakeable, overpowering feeling of failure. By the time I saw the finish line 5 hours after crossing the start, I had arrived at a numb thoughtlessness, my only focus on finishing. I sprinted the last few meters, only realizing after that at some point I had stopped breathing and held my breath. Slogging through 26.2 miles was one of the most difficult things I have ever done and, as in other marathon-like moments in my life, having friends cheering me on or running along with me made all the difference in my ability to push on through.

While running the marathon was not the most enjoyable experience, training for it taught me a coping mechanism that I continue to use. Running, whether for the purpose of training for other races or simply for the sake of running, is a way I have found to center myself. Going on a run gives me a small moment of the day where I can either concentrate on my footfall and my breathing or the path in front of me. When I’m running, I often find myself being entirely present. I may consider projects and problems I am working on, but, by and large, all of my thoughts are focused on how I’m moving, where I am, and where I am going in a very finite sense. I am not thinking about my next steps in life, but quite literally my next steps at that moment.

I have been doing short runs around the peninsula here during my time in Laos, but this morning I decided to go on a longer run. I had heard that there was a water buffalo dairy farm a reasonable distance away from town and set out early in the morning with that destination in mind. What I thought might be closer to 9ish miles ended up being 15 miles (24.14km) of steep hills that had me alternating between running and near-hiking.

As the dawn passed into the morning and I ran through neon green rice paddies and dusty, sepia villages on a run much longer than anything I have done lately, I met the curious faces of local villagers and the mischevious glee of local children. For quite a distance at around mile 8, I had a crew of school children jogging alongside me chanting, “Money! Money! Money!” They stopping following me when they realized they weren’t going to get anything more than a smile and slightly out of breath laughter, as what I had with me I needed to keep in case of emergency. Older children and adults piled on passing motorbikes gave me a wave, a “Sabaidee!”, or raised an eyebrow at the very sweaty foreigner running by.

There have been many times in my life where I have thought, “if I ran that marathon, clearly I can get through this.” I anticipated that I might be thinking such a thought at this point of my time in Laos. The reality could not be more different. While this experience has been a challenge, full of very steep curves of both the physical and learning types, the idea of only having 26 more days here at this hospital and in this country fills me with a deep sadness and a frantic urge to accomplish all the things I set out to do here. This morning’s long run was as much a test of endurance as a reminder to treasure and recognize the ephemerality of my time in this country and in this community. A very wise friend of mine has the tendency to remind everyone she meets that things are “only special when they’re special.” Laos, LFHC, and all the patients, families, and staff I have had the honor of meeting and working with are so, so very special. I dread the idea of 26 days passing by too quickly, but I go into these last few weeks with the reminder to be acutely, actively present, paying attention to every breath, every footfall, and each and every special person with which I share them.

The Magic of Play

I’ve mentioned it many times on this blog, but I am continually amazed by the simple magic of common things here in Laos. This afternoon, the monsoon stopped and the rain clouds parted, exposing the sun and the blue sky for what felt like the first time in weeks.  Not one, but three nurses stopped me as I was going up the stairs in my squelching wet sneakers to say, “Look! Sun!” There’s a childlike joy in the simple things here and nowhere is this more evident than in play.

As a child life specialist, much of what I do with patients, siblings, families, and staff in the clinical setting relies on communication. Here in Laos where I don’t speak any of the three main spoken languages with any sort of fluency, I rely on play as my form of communication. I play through procedures with pretend and real medical tools at the bedside, giving patients control over the care of a doll or stuffed animal prior to or after a procedure. I use play to distract during procedures, to normalize the hospital setting, and to assess what a child can do and what they understand about being in the hospital. My child life coworker speaks all three languages and there are times when the limits of my ability to communicate via play necessitate that the two of us enter into a dual translator, play-maker relationship wherein I scaffold his conversation with the patient while continuing to communicate through a play based medium, but many of my interactions with patients and families rely on the very few words I know in Lao, Hmong, or Khmu and what I can communicate through play, body language, and facial expressions.

Given how little language I am able to use, I am equally continuously surprised by the amount of trust patients and families seem to place in me. It may be that I am wearing scrubs like the rest of the medical team or that I am obviously not local and perhaps am thus lumped in with the rest of the foreign volunteers caring for the children in the hospital, but, though I usually am only able to butcher the word for play and point upward to communicate my offer of a trip to the physio-playroom, many children and their families eagerly get out of bed and follow me step by step upstairs. Such was the case for one patient earlier this week.

Bumped from the surgery roster, a school-aged girl had been waiting all day for treatment of a fractured elbow, unable to eat or drink while waiting for anesthesia. She and her parents were understandably frustrated to learn late in the day that she would not, in fact, be going to the operating theater that day and would have to wait until tomorrow. After a chance to “gang khao” (literally “eat rice”, but a phrase used to refer to all times of eating), she followed me up to the playroom. I had seen her drawing in a notebook from across the room earlier in the day and, when she did not express interest in joining in the group of school-aged boys sending tiny cars ricochetting around the room on ramps made from cardboard, medical tape, and coconut shells, I offered her a set of watercolors. I sat next to her on the floor, paint brushes, watercolors, and watercolor paper between us and showed her first how to wet the brush, how to wet the paints, and how to put the brush to the page. We painted together, filling page after page with vines of jungle flowers, birds, and the ever-present image of dark green mountains with a blue river gushing down between the hills. Where at first she had seemed a bit apprehensive, she was soon smiling and chatting away, pointing and naming things and colors on the page to teach me new words: “si fa” for blue, “si kiow” for green, “si deng” for red, “si leung” for yellow, “si moon” for purple, and “si aeng” for pink. After a while of painting, I offered her a set of crayons and showed her how to create crayon resistance with the watercolors. From the way her face lit up when the swirl of white crayon emerged from the stroke of blue watercolor, you would have thought I had performed the world’s most impressive magic trick and from the pride that radiated off of her as she exposed her own white crayon sketches, you would have thought she had just conquered all of magic.

The magic of play as a tool for communication and trust building amazes me in each supportive relationship that I and my coworker build with patients, families, and staff, but it is so much more incredible when play enables patients who have been fearful or withdrawn to become comfortable and begin to engage with others. Midway through last week, a preschool-aged child was admitted with a painful, festering lesion on her scalp that her father reported had been there for the past two years. Despite many attempts to play with this preschool-aged girl, my coworker and I could not seem to help her feel comfortable enough in our presence to engage, though she would fiddle with the toys of neighboring patients’ beds when perhaps she thought no one was looking.

I happened to be in the inpatient unit this morning when the patient in the bed next to this preschooler returned from the operating theater. Coming out of anesthesia and waking up to considerable pain, the preschooler’s neighbor was in a bit of distress and surrounded by the medical team, her family, and my coworker. The preschooler sat rigidly on the bed, giant eyes peeking out from below her head dressing at the commotion. I squatted next to her, putting myself between her and the action and took out a stuffed monkey and medical play items from the drawstring bag I carry on my back. Her gaze flitted back and forth between the team surrounding her crying neighbor and myself, as if unsure of which posed more danger. Smiling, I started to play. I swung the monkey back and forth, having him make quiet monkey noises and jump up and down, blowing kisses. The ghost of a smile began on her face. I picked up the pretend otolaryngoscope and checked the monkey’s ears, used the bring pink pretend stethoscope to listen to his chest, and checked his temperature with the pretend thermometer. By the time her next door neighbor was calm and comfortable, the preschooler and I had wrapped her monkey’s head with a bandage that looked just like her own, checked his vitals, given him many shots, blown bubbles to distract him, and covered both the monkey and the preschooler in stickers. The ghost of a smile had grown to a shy grin that she wore for the rest of the day. I later glimpsed her outside on the hospital playground squatting next to a gaggle of sibling toddlers, blowing bubbles to their raucous glee.

The magic of play amazes me not only in its ability to bridge linguistic and cultural barriers, but also in its ability to empower children, families, and staff to recognize and nurture their resilience. I’ve mentioned it in many posts about my time in Laos and I am certain I will continue to mention how incredibly humbled and inspired I am by the resilience of the people here. As they play through unspeakable difficulties, the patients, families, and staff in Laos truly create their own kind of magic.

Making a Difference – on Volunteering and Voluntouring

When I began looking for an opportunity to practice child life in unique settings many months ago, it was paramount to me that the location and program I found was not voluntourism. Volunteering here in Laos with Friends Without a Border has offered me the chance to take part in an organization that is truly creating positive change and scaffolding sustainable pediatric healthcare infrastructure that is sensitive to the cultural and logistical needs of its setting. As I approach the two-thirds mark of my time here, I find myself reflecting further on the impact I may have had and what legacy I may leave when it comes time for me to go.

In reflecting, I find it important to differentiate what I hope not to be from what I hope to be during my time here on this adventure and on other adventures I may have in the future. Voluntourism is a label which means precisely what it sounds like: traveling to a foreign country or location different from one’s home and volunteering some sort of service. What sets voluntourism apart from volunteering is who primarily benefits from the action. Unlike in volunteering, the primary individual who benefits from voluntourism is the voluntourist. Voluntourism tends to be comprised of short, focused missions in which the voluntourists offer their service to the locals in a means and with a medium that the locals cannot continue to provide for themselves after the voluntourists have left. The othering of local cultures, customs, and lived experiences is quite implicit in acts of voluntourism wherein voluntourists take on a savior-like identity, riding in to save the day on the spoils of their privilege and, for some brief period, creating changes in the lives of local people before riding back off into the sunset. Classic examples of voluntourism are the pictures you may see on social media of smiling Americans surrounded by “starving children” with the hashtag “blessed” for the spectacle of poverty or short-lived medical missions in which clinicians arrive, fix a couple hundred cleft palates, and then leave. This post is not to say that voluntourism is entirely bad. It definitely has some benefits, especially as in the examples above for the smiling Americans who hopefully would gain a better understanding of their privilege and for the couple hundred people whose cleft palates were fixed, but the root problem of voluntourism is its lack of sustainability. When voluntourists leave, by and large, the big issues that voluntourists came to address, such as poverty, starvation, and lack of healthcare infrastructure, remain and persist. Volunteering, in contrast, seeks to empower and educate people to address the underlying big issues and create change that is sustainable and sensitive to local culture and customs. Rather than making a spectacle of the issue and entering into some sort of neocolonialist relationship with local people, volunteers in programs like the one with which I am currently affiliated hope to meet the local people where they are in their lived experiences and work with them to empower them to solve their problems. It has been exceedingly important to me that I am a volunteer and not a voluntourist during my time here in Laos.

As a child life specialist from a Western culture with training in Western healthcare environments, the interventions that automatically come to mind for me are rooted in Western traditions and values. Moments where I find myself perhaps toeing the line between volunteering and voluntouring are moments that are especially culturally charged, such as bereavements. In reflecting on the sustainability of the impact I am creating, I find myself especially questioning my actions in going into the morgue and creating footprints of the deceased patient for her family, as discussed in a previous post. While it is true that the family greatly appreciated the intervention, such an action may not be repeatable as there are cultural taboos surrounding dead bodies that may prevent a local individual, such as my child life coworker, from providing the same intervention for a family in the future. Footprints of the dead is something that I, as a Westerner, can provide while I am here, but it is not a sustainable action.

A key aspect of my role where I have been evaluating whether I am volunteering or voluntouring is in my supervision of my child life coworker. A couple blog posts ago, I discussed a visit I had made to a local school here in Laos and how the educational system’s rote memorization and recitation style of teaching has seemed to result in a profound lack of critical thinking and creative problem-solving skills that I have found may impact how local medical staff thinks about patient care. In many ways, my coworker is an exception to this norm. He is creative, flexible, deeply compassionate, and empathetic. I have hoped that my time working with him has helped to expand upon his skillset and nurture his potential as a child life practitioner. In the past few weeks, I have been immensely proud of the way he has stepped out of his own comfort zone, verbalizing the reasoning behind the choices he makes in patient care, charting, preparing patients for procedures, prioritizing care, offering choices and open-ended play opportunities, and advocating for the needs of patients and families to fellow staff. Much of the dividing line between the sustainability of volunteering versus voluntouring in the foreign, clinical supervisors here has resulted from how people think and perceive patient and family needs in a Western or Lao thinking style. In my supervision of my coworker, my self-evaluation has focused on whether or not the standards I hold and the goals I set are based in Western or Lao systems of thought and whether or not they should be based in Western or Lao systems of thought in order to best scaffold the creation of a child life program within a growing pediatric healthcare infrastructure which is in and of itself perhaps a Western concept.

On Friday morning, I had the opportunity to volunteer at the hospital in yet another way that prompted this volunteerism/voluntourism reflection. During morning rounds, we were discussing the medical plan for a school-aged child with a severe form of anemia. Among other things, he desperately needed a blood transfusion. The blood bank, however, was out of blood. Back in the US, I donate blood as frequently as I am able and had no qualms about donating here in Laos. When I have donated in the US, I have always been curious about where my blood goes, if it actually ever is used, and what the whole process is like when it leaves my body. Given the needs of the patient and the empty circumstances at the blood bank, I had the unique opportunity to do a direct blood donation.

I crossed the muddy road from the hospital, passed the morgue, and entered the blood bank to fill out the paperwork and give the patient’s name. Donating was much faster than back in the US given the larger gauge of needle used for the process and, despite the hot blanket the blood bank worker kept insisting I be covered in, the donation process was quite comfortable and painless. I found it utterly fascinating to walk back to the hospital next to the blood bank worker holding a bright red cooler with a dark red pint of me still hot inside for testing and absolutely mindblowing to watch hours later as my blood flowed steadily into the arm of the sleeping patient, actual pieces of my body causing direct, immediate positive change in his.

In moments where I am literally giving of myself to patients and families, where I am offering interventions that may be rooted in Western-based practices, and where I question whether the supervision I provide is sustainable, I wonder whether my actions here in Laos are purely volunteerism or whether, though I intend for my role here to be one of a volunteer, I may sometimes flirt with the role of voluntourist. As I enter my last month here in Laos, I will continue to question and reflect on the impact I am having and what legacy I am leaving, focusing on making a positive difference that is sustainable, empowering, and nurtures the potential of the staff to offer the best possible care to patients, families, and one another.

So Very Lucky

On Monday night, a hydropower dam in Attapeu province of Southeastern Laos collapsed, causing flash flooding which submerged surrounding villages and reached all the way to Cambodia. According to the highly controlled governmental news reports, approximately 6,000 people lost their homes and livelihoods in the flooding, at least 26 people have died, and over 131 people are still missing.

I learned about the collapse as I was leaving the hospital on Tuesday evening and returned Wednesday morning expecting to be somehow indirectly impacted by this manmade disaster. I brought a map of Laos with me on rounds, checking in with patients and families about where their village was and anticipating that I or one of my coworkers rounding with me might have to break the news of the dam collapse. Luckily, given the hospital’s location in Northern Laos, no patient or family had lost their home. Along with the many other members of staff, I checked in with people frequently throughout the day, inquiring if their family had been affected and if everyone they knew and loved was safe. Each patient, family, and staff person I checked with here in Northern Laos assured me that they and their families were okay.

At the very end of the day, this ongoing conversation about the dam collapse derailed my child life coworker and I from our charting, sending us to google maps. Using the higher detailed map, my coworker zoomed in on Laos, showing me the villages and provinces where his family lived, where he grew up, and how far they were from the flooding as well as where other dams were that we could worry about. In the course of this conversation, we began to discuss the places we grew up and, with the magic of google, I panned over to the United States and zoomed in on my hometown until street-view presented a high-quality image of the house I grew up in. My coworker explored the image with the computer cursor, repeating over and over again how lucky I was. His words caught me off guard. In the whirlwind of the day, I had been so focused on the flood and its implications for patients, families, and staff that I had lost sight not just of how lucky we all were to be in Northern and not Southeastern Laos, but also how lucky I was to be privileged enough to know that this devastating tragedy will not directly affect me in any way and how privileged I am to have had the life I have had.

There has been no space here in which I have felt as lucky and privileged during my time at the hospital than in the NICU or Neonatal Intensive Care Unit. In some ways, my own life began in somewhat similar circumstances to many of the babies in the NICU here. My triplet brothers and I were born at 28 weeks and spent many months in the NICU, growing big enough and strong enough to go home. The neonates in the NICU here in Laos tend to be 29 weeks at the earliest and are battling jaundice or sepsis or other illnesses and injuries suffered in their short time of life. The isolettes, like the beds of the inpatient unit, are packed close together, the room hot enough despite the fan not to require any additional warming units for the neonates. Mothers, fathers, grandparents, and extended family sweat together, sandwiched around beeping monitors and squirming newborns. As in inpatient, there is no privacy and the lack of privacy serves to create its own kind of cohesion, uniting new parents in their own NICU village.

I have been spending a lot of time in the NICU lately and have made my own strange identity in the NICU village. Child life functions in its own unique way here in Laos and, in some cases, there are positions I find myself filling which I know in any other hospital setting I would not necessarily be allowed to be doing. One unique role I have taken on is specific to a particular patient in the NICU.

Over the weekend, we had a miraculously lucky baby come into the hospital. A nurse in training happened to be driving home with her family. When they pulled over to relieve themselves in the bushes, the nurse saw a newborn silhouetted in her headlights in the trash heap on the side of the road. As a nurse in training, she knew to get the neonate warm, cut the cord, and rush her to our hospital. To the credit of that nurse and the excellent medical staff here, the tiny little girl is now doing well. There are certain things that are crucial to care of infants, however, beyond extensive medical care in the NICU environment. Attachment, especially, is essential for infant growth and development. In a case like this one, however, where there is no primary caregiver, I have found myself fulfilling the role.

This past week, I have spent a few hours every afternoon with the miraculously lucky baby. At first, my role was similar to the child life role I have played with all the babies in the NICU, providing positive touch, appropriate sensory stimulation, and modeling and supporting caregivers. As the week has gone on, however, I have found myself stepping more into the role as has been possible in her care as well as stepping more into the NICU village, less an observer and member of the medical team and more one of the locals. My interactions with this baby and her neighbors have ranged from modeling how to safely hold a baby on CPAP to how to gravity NG feed the sleeping neonate on your chest to a proper skin to skin snuggling technique.

As I sat in the hot NICU this afternoon, wearing the lowest cut tank top I own with the miracle neonate slumbering cuddled against my skin, one of the grandmothers of another baby came over to me. She had been watching me from across the room for about twenty minutes. At first, I had felt a bit embarrassed by her stare, unsure if she was judging me for the way my bright orange sports bra peeked out from the very revealing tank top I had donned for skin to skin purposes, but in holding the infant, feeling her snuggle and relax against me, and in realizing that her heart rate had finally dropped for the first time this week into a range that put her out of tachycardia, I had lost all semblance of modesty and taken up grinning back at her whenever her stare fell on the two of us. After about twenty minutes of this odd exchange, the older woman rose from beside the isolette she was supervising and walked all of two steps to the other side of the room where I sat. She squinted down at the infant who was grasping my finger and wrinkling her ear against my sternum, snuggling as much of her tiny body against mine as she could and then squinted at my face before finally breaking into a grin of her own.

“She happy. You happy. So happy. Very lucky,” she spoke to me in broken English before returning to her grandchild. I could think of no other reply but to echo her words. I am so happy and so very lucky.

My entire time here in Laos has been a continual exercise in humility. I am so honored to be able to participate in a mission that is empowering the people here to learn how to provide and sustain pediatric healthcare at such an acute and critical level, to take part in a medical team that provides the life-saving care that the children and families in Laos so desperately need, and to learn with and from the patients, families, and staff as much if not more than I teach them. It is even more of a special honor to be handed the chance to be an attachment figure, a Harlow cloth monkey for a NICU baby given my own history as a NICU baby. Between the dam disaster and my time in the NICU, this week, in particular, has reminded me of all that I have to be thankful for and all that I have to offer. In the words of the NICU grandmother, I am so very happy and so very lucky.

 

For more on the dam collapse and its effects:  https://www.nytimes.com/2018/07/25/world/asia/laos-dam-collapse-rescue.html

https://www.theguardian.com/world/2018/jul/26/laos-dam-collapse-sends-floods-into-cambodia-forcing-thousands-to-flee