Looking back at 3 Months in Thailand

On January 1, Ed’s flight from New York and my flight from Sydney both landed at Phuket airport in Thailand. We didn’t speak a word of Thai and had only done basic research on the region. On March 31, we had our departure cards stamped at Friendship Bridge IV and entered Laos. Between those dates, we were given the opportunity to explore the country, try all kinds of foods and become fast friends with some really jae dee (kind/good hearted) people.

Our final itinerary: 1- Ranong 2- Bangkok 3,8 - Ayutthaya 4- Pak Chong 5- Khon Kaen 6- Phitsanulok 7- Sukhothai 9- Chiang Mai 10- Mae Hung Son 11- Pai 12- Chiang Rai

Our final itinerary:
1- Ranong
2- Bangkok
3,8 – Ayutthaya
4- Pak Chong
5- Khon Kaen
6- Phitsanulok
7- Sukhothai
9- Chiang Mai
10- Mae Hung Son
11- Pai
12- Chiang Rai

Continue reading

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Postcard from Thailand

Since finishing up our volunteering gig in Southern Thailand, I’ve been accumulating stories and reflections, but I’m no professional travel blogger and just can’t seem to make time for the occasional update. I also have trouble with writing just a few words – it’s either 3000 words or it’s nothing. And with my two modes being “on-the-go” and “asleep”, you can imagine how often I want to glue my butt to a chair to type up 3000 words!

At the same time, I do want a written trace of my travels because there’s no way I’m going to remember all this in a year.

So for the sake of journalling, here’s a somewhat-postcard format of a blog post.

Let’s start with a postcard photo. How about this one:

Dusk in Khao Yai National Park near Pak Chung, Thailand

Dusk in Khao Yai National Park near Pak Chung, Thailand

Dear postcard readers,

Finished volunteering in the South at the end of February. Was so hard to leave! Miss the staff and the kids at school very much. Also miss the food.

Went to Bangkok, stayed in a posh neighbourhood, visited touristy places. Took the train 90 minutes north to Ayutthaya to admire Thai ruins. Then took train east to Pak Chung to visit Khao Yai National Park. Didn’t see any wild elephants :( Did see some elephants by the road outside the park but unsure if they are wild. Our tour did not stop for them. Saw lots of bats and creepy crawlies. Took bus north to Khon Kaen because wanted to see Isaan region of Thailand. Khon Kaen ended up being beautiful but modern city. Loved Khon Kaen but will have to try again for authentic Isaan experience. Then took bus west to Pitsanulok. Scored front seats on top level of double decker bus. Very scenic trip through the mountains. Took bus from there to Sukhothai to see more ruins. Fell in love with Sukhothai countryside. Took excellent bike tour and visited several craft shops. Took bus back south to Ayutthaya to replace lost souvenir then took night train north to Chiang Mai. Visited museums, took street food tour and got massages. Leaving tomorrow by bus to Mae Hong Son further north west of here.

Miss you all, hope you are well and wish you were here.

In case that was too confusing, here’s map:

itiniary chiang mai

The Numbers:

1- Ranong, South Thailand
2- Bangkok, Central Thailand
3- Ayutthaya, Central Thailand
4- Pak Chung, North Eastern Thailand/Isaan
5- Khon Kaen, North Eastern Thailand/Isaan
6- Phisanulok, North Thailand
7- Sukhothai, North Thailand
8- Ayutthaya, Central Thailand
9- Chiang Mai, North Thailand
10- Mae Hong Son, North Thailand

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On Culture Shock

It was about 1pm. We’d been sitting on the concrete floor for over an hour with 30 children, many of them preschoolers with autism. The caretakers were sitting at a table in the middle of the room talking to each other and looking at their phones. There were no toys, no pillows, no distractions. If the kids got too noisy or too squirmy they were harshly scolded or slapped on the hands. I didn’t know how much longer we’d be stuck in here. The scene, after a similar one this morning (but that only lasted about 30 minutes) and some support staff members who were harsher than usual was too much for me. My eyes welled up with tears and I had to run outside to find a secluded spot for a good cry.

When travelers talk about “culture shock”, they go on about the food, the smells, the architecture (or lack thereof), but seriously, unless you’ve been super sheltered or are somewhere extremely remote, those things are trivial.

No, culture shock, the brutal in-your-face culture shock, happens when your beliefs get tugged at. And not your “you believe in God, I don’t really have a religion” beliefs either. Again, as long as your mind isn’t a narrow bridge, those are pretty trivial. I’m talking beliefs like about how life works, which values to prioritize, how you treat others. Controversial beliefs, you know, such as how people should behave according to their gender, how individuals should treat their families, how families should treat individuals, how friends should treat each other. And the biggest, baddest one of all: how children should be raised.

At that moment, my Western beliefs that school time should be structured, that students should be stimulated as much as possible and that they should be able to run around or play with toys during down times were facing the equivalent of a gang of sketchy dudes with baseball bats in an alley.


A bit afterward, I sat with Ed to talk about it.

Ed: So, what bothered you in there?
Me: I couldn’t stand to see all those kids penned up like that. Like cattle!
Ed: Ok. First of all, it was a big room. Second, it was air conditioned. And finally, the kids were having fun! Some of the staff were interacting with them, some were sleeping and the others were playing clapping games.
Me: But there were no toys! Nothing educational! Not even any music!
Ed: Sometimes when I was a kid there were times I had nothing do to do. You know what I did? I used my imagination.

Together, we reframed our observations of how the school worked. (Since we were both raised in cultures different from the cultures of our parents and spent our childhoods switching back and forth between frames of reference, reframing cultural observations is something we do together often, almost as game.)

Bringing up bébé in the West

In the West (Euro-American) culture (or in my perception of the West), kids, special needs or not, are stimulated whenever they are not in bed. Down times are accompanied by toys, playgrounds, TVs and, for this generation, computers or smart phones. Days are tightly structured with school, homework, sports, arts and other hobbies crammed packed into a few hours. (No wonder anxiety, depression and insomnia seem to becoming the norm rather than the exception!) Most parents recognize harm in aggressive discipline, but many don’t understand alternatives so they pass off behavioural education to the school and daycare systems. The ultimate goals for an individual is to be self-sufficient, hard working and able to support a spouse and children. Achievement of these goals is demonstrated by an accumulation of knowledge (not exclusively academic) and material wealth.

Western children requiring a specialized education are expected to work toward the same goals. Their education is based on developing independence and the ability to function within a structured environment. Social skills are important, yes, but they are tool toward autonomy rather than social harmony.

Bringing up bébé in Thailand

When it comes to education in Thai culture, we’ve had to guess.

With no one at the school speaking enough English to explain something as complicated as culture (and even if there had been, I’m not sure anyone had been exposed to other cultures enough to be able to describe their own – it’s pretty hard to name and describe values and beliefs you’ve had your whole life until you’ve had something to contrast them with) we were on our own. Ed offered a perspective based on his Chinese upbringing but while Thai culture is closer to Chinese culture than Euro-American culture, they aren’t identical. As for me, I went home and read everything I could find on raising children in Thailand, but there’s a pretty wide gap between literature and reality.

We figured family is important. I suggested that families here in Thailand might even be horrified to hear how crucial “moving out” is in the West and how most individuals who are unable to live independently live in support homes as opposed to with their families. So while “successful” parenting in the West might translate to raising a child who becomes autonomous and is able to start a new family early in adulthood, “successful” parenting in Thailand might translate to raising a child who participates actively in family life and who has harmonious interactions with others.

From what we can tell, hierarchy based on age and role (such as teacher vs student) is quite pronounced in Thailand too. When reading testimonials from Thai teachers attempting to use techniques developed in the West, though, I realized that this hierarchy isn’t so much based on the desire to dominate (which is how us Westerners tend to interpret hierarchy), but rather out of a “tried, tested and true” mentality. Those teachers were open to trying these techniques but were concerned that if their students stopped being afraid of them, they wouldn’t be able to learn anything. So the need for hierarchy was actually for everyone’s benefit, not just a “power trip” for those at the top.

As for work, it seems that, in Thailand, everyone works. There’s no such notion as overstaffing here. Even if you go to Dairy Queen in the late evening, you’ll still be served by 6 people. This must, I imagine, alleviates a lot of stress in the workplace. Staff take turns looking their phones, answering personal calls, chatting with their coworkers yet still manage to put out pretty good service. (I think this is a little different in tourist heavy areas, but here in Ranong, service has always ranged from “quite good” to “exceptional”) Unlike the West, where work is generally perceived seen as a necessary evil and where getting the most done with the least resources possible is the key to success, work in Thailand seems to be perceived as a fun social activity that also helps pay family bills. And because businesses hire so much staff, I imagine that there are a lot of job opportunities for unskilled labourers (at least in cities like this one), so even the most challenged of children at our school can probably find work and lead a relatively normal life once they gain some maturity.

Adding context to the scene

Back to that room.

We were sitting there because the military was taking photos of the empty classrooms (I’m not sure why they were doing this, but they did make a donation that morning and they are technically the government so who knows.) It’s too hot outside at midday for the kids to safely play on school grounds and being in air conditioned room is actually a treat. They were to return to their classrooms for nap time as soon as the rooms were free. It was just taking longer than expected.

Sitting quiet and still while doing nothing is an obsolete skill for most in the West, but if you consider that many Thai children frequently follow their parents to work, or are expected to attend family gatherings, or go out in public, you realize this skill is probably quite useful for them. And it’s not like they were forced to be statues either, some of the staff were interacting with the younger children, and the other kids were developing their social skills by interacting with each other, using their hands and feet as toys.

As for social skills, we noticed right away how well socialized the kids were. While some of the preschoolers cry for their mothers and the 4-7 year olds struggle with sharing, almost all the kids seem to have above average social skills when compared to their Western cousins. Eye contact is good, communication is effective (I actually had an easier time communicating with the kids than with the adults), fighting is rare and the older kids naturally look out for and help the younger kids. They pick up on cooperative games so quickly that I can’t tell which games are new to them and which they’ve known all along. And yes, this includes most of the kids with “severe” autism.

Somehow those long wait sessions were indeed educational, education being so much more than just learning facts and applying academic skills.

On Discipline

Discipline is probably the most controversial topic in child rearing anywhere. People just feel so strongly about the rights and wrongs in teaching your kids, well, right and wrong.

For me, the constant scolding (in a harsh, shrill voice) got under my skin. It was less about Thai culture, I think, than because of my experience with it back home. I don’t care for yelling. I was yelled at a lot as a kid (by teachers, by my mom – it’s just how things were done back then) and all it accomplished was develop my ignoring skills. Then, when I worked with children, yelling and harshness was seen as a loss of control, as a lack of empathy and as not having the competence to think of more child/situation-tailored solutions. The slapping of children in Thai schools doesn’t bother me as much, mostly because the slapping is very light, pretty much just a formality, but I still saw it as a waste of energy, especially when the child probably doesn’t understand what he’s being punished for anyway.

Ed offered a Chinese perspective: “My mom, my friends’ moms, my Chinese teachers, they all talked to me like that when I was little. With the exact same voice. I think that’s just how Asian women are expected to talk to children.” The testimonials I mentioned earlier suggested something along that train of thought, that teachers were worried that children wouldn’t behave or learn if they were not treated like this.

We can also consider it from the perspective of what earns respect for a teacher in the West. A Western teacher is respected for being empathetic, adaptable and interesting. So a teacher who scolds a lot in an annoying voice is more likely to be disrespected (hence my disdain for yelling). In Thailand, a teacher is automatically respected because they have knowledge to share. They are inherently “superior” in the social hierarchy. If they start treating the children as equals like a Western teacher would, they would theoretically lose their spot in the hierarchy and thus not be able to share their knowledge.

It must be noted too that the certified teachers at school, the ones who went to university (aka were expose to Western teaching techniques) were far less likely to use yelling and scolding to do discipline. (Which is actually not that different from back home – it seems that Western teachers and support staff, and even people like nurses and health care aids, who are older or less educated to tend to be gruffer and resort to yelling more than those with more extensive training.)

Where are the visual aids?

Visual aids have a huge place everywhere in modern Western teaching given that not all of us are blessed with being auditory learners. They are, however, especially crucial with special needs children, particularly with autistic children since struggles with spoken language are, like, a big part of what autism is.

It seems that visual aids are indeed used in some schools in Thailand and are taught in university (one of the teachers, I think she is a speech therapist, mentioned having used them at other sites in the past), but this school doesn’t use them. They also don’t use sign language with non-verbal children (they do use hand gestures for “hello” and “thank you” but because those gestures are part of normal interactions in Thai culture, they don’t think of them as sign language) All of my training has been about facilitating communication through visual aids so I had no idea what do.

I did make some pictographs (cards with pictures that can be used to communicate a need, discomfort or a want like thirst, tiredness, hunger or going to the bathroom) but since I was the only one using them, they ended up being more like fun flashcards or vocabulary builders than communications tools. I use sign language to back what I say too, a mix of Thai sign language and the hand signs I used back home, and the kids are somewhat interested, but again, no point in teaching them if no one else is on board.

I wanted to make visual schedules and timers too but ended up deciding against. After all, these kids were pretty good at communicating already. Thai life isn’t scheduled and timed the way Western life is either. Adults do go to work in the morning, come home at night and have hobbies, but routine, at least in more rural areas, isn’t as fine tuned or as strict as the routine we know. Oh, and nothing ever goes as planned. Some days cars break down. Sometimes there are random holidays. Sometimes people are late. For these kids, I decided, a schedule would be at best a waste of time, or at worst a source of frustration as it would rarely be followed. The notion of trusting one’s superiors makes me cringe, but given the cultural context, these children will probably gain far more by noticing cues from their parents and teachers than from a piece of paper. They would also gain a lot by learning how to deal with things they can’t control than by learning to control as much as possible.

One kid who was especially problematic by Thai standards (his behaviour was pretty average by Western standards) eventually got his own schedule, but he was the only one for whom I thought it might be worth the effort. By the time he learns to use it, I’ll have left, so I doubt it will be all that useful, but at least all the staff are familiar with it and might use it down the road if they see the need.

The ultimate ultimate goals are always the same: happy, healthy kids with bright futures

After taking a step back and putting everything I witness into cultural context, I ended up with a lot of respect for what they are doing at school.

Perhaps these children won’t be pushed to their full potential academically, but they are pushed hard where it matters for them. They’re learning to be good family members (remember that they will mostly likely live with their families instead of in a group home when they grow up), they’re learning patience, they’re learning general routines such as washing your hands before eating and brushing your teeth after, they’re learning table manners, they’re learning how to look after those lower than them in the social hierarchy (the older children comfort and teach things to the younger children), they’re taught how to cope with extreme Thai heat and they are taught some manual skills that will help them be employed later on. Perhaps they won’t have the experiences and resources their Western cousins receive (but they do receive a variety of experiences- for example, just two weeks ago they went horseback riding!) but I wouldn’t be surprised if their adult lives are happier and more similar to those of their peers when compared to Western persons with special needs.

As for how I choose to interact with the children, it isn’t possible for me to let go of my Western training (one of the teachers asked me to slap a misbehaving child once and I couldn’t bring myself to deliver more than a gentle tap. Physical discipline has been drilled out of me pretty hard!) and I turn a blind eye to a lot of behaviours that Thai teachers would correct in a heartbeat. I do have to admit, though, that because these kids are so well behaved and have such good social skills, they learn new games and new skills much faster and have way more frequent positive interactions with me than what I’m used to.

So perhaps there is a method to the madness and it just takes a step back (or two or three) to appreciate it.

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Extending Our Thai Visas

I’ve spent the last week locked in our relatively small (I say relatively because most of the time space is no problem, but during a few days of quarantine it gets real small, real fast) with my new companion, Laryngitis. Laryngitis wasn’t very nice. He’s mostly gone but left me with a post-viral cough, ensuring that no one within hearing range will get any sleep from now on. (Post-Viral Cough and I have a long history, last time it stuck around for 9 months. It included one ER trip, several doctors visits, a fortune in asthma meds, lots of cough-induced vomiting and the most intense abs workout ever. The time before that was less extreme but I did cough myself into in a back sprain which was really, really, really not fun. I wonder what exciting stories I’ll have to tell about this episode!)

Anyway, I sat on my butt from Tuesday to Thursday, not wanting to hand out my germs to the kids at school (didn’t want to start the next pandemic, you know!) and school was closed Friday. By Friday, most of my voice was back and I didn’t care enough about the coughing to let it hold me down (Post-Viral Cough is such a regular customer in my life that if I gave into it, I’d never get anything done) so we stuck by our original plan for the end of week 6 and biked to Immigration to extend our tourist visas.

I feel like I should have a crazy story here, but I don’t.

Immigration is a huge red building on a major road, you can’t miss it. It takes about 30 minutes to reach by bike. Figuring out where to go isn’t all that tough either – the bored taxi drivers hanging around are quick to point lost tourists like us in the right direction.

Ranong, as I love to point out, is hardly a bustling tourist and expat center. It does, however, share a sea border with Myanmar, so I’m sure work at immigration is never boring. The big immigration police trucks with their big cages are quite the sight and always make me wonder how often they have to use them and whether they ever fill those cages up.

As one could expect, the outdoor (but nice and shady) waiting area was alive with Burmese families and workers filling out forms and waiting to submit their papers. We were about to line up to take a number when another Westerner walked by us and disappeared through a blue door. It had a “One Stop Station” sign on it and listed a bunch of services you could obtain behind that door (like, you know, a visa extension). We gave up on being numbered and followed him in.

I’d not sure if it was because it was Friday or if every day kinda looks like that but there were 4 people ahead of us. It wasn’t lost on me that the Burmese were made to wait outside while us foreigners got to chill with some air conditioning. I guess that’s where all the tourist tax goes.

Filling out the form was probably the longest part of the process. It can be made shorter by printing it off the website and filling it out beforehand, but seriously, who backpacks with a printer? We also had to pay a reasonable 5 Baht to photocopy our passport, departure card and visa, which can probably also be done ahead of time by those backpacking with a photocopier.

Then we just waited our turn, handed in our forms and passport photos, paid, smiled for some photos (they record photos of everyone applying, I guess they’re more likely to be up to date than the ones we hand in) and receive a stamp with the extended date. Just like that.

And that’s how you extend your tourist visa. Maybe if you look suspicious they give you a harder time but we had no questions asked. I had heard rumors of proof of onward travel too, but that was also a non issue (perhaps it’s different for those who have a visa-on-arrival or no visa at all).

Now we’re all set for our upcoming trip to Bangkok, to Isaan and to the North!

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5 Weeks In – Reflecting on our Voluntourism Experience

We’ve gotten well past the halfway point in our volunteering session at the Ranong Special Education Center. 5 weeks completed and 3 left to go!

Us with the team! (And a few visiting teachers from other schools.)

Us with the team! (And a few visiting teachers from other schools.)

I spent the weekend drafting a compilation of my notes to guide the next volunteers while on the side I’ve had a post written by Ken Budd at Intelligent Travel on the myths around voluntourism open on my phone. The combination has had me reflecting on my own experience with voluntourism and on what hard earned wisdom I’d like to pass on to others.

When I started looking into volunteering opportunities in South East Asia, I devoured whatever I could find on the topic so I was well aware that, yes, voluntouring is a controversial holiday activity. It seemed, though, that those hating based on personal experience were those who had gone into projects inadequately prepared, with limited volunteering experience and idealistic expectations.

Not wanting to, you know, end up bitter like them, I armed myself with a plan. Now that we’ve been doing what we can to help out here in Thailand for more than a month, I feel it’s time to evaluate.

Preparation: Choosing a project

I heard the horror stories about orphanages reportedly “buying” children for volunteers to look after (you would think that there are enough children needing a home that this wouldn’t be necessary, but I guess not), so I wanted to stay clear of orphanages. I didn’t absolutely need to work with children anyway, but I had in mind that if I did, I would look into volunteering at a school. If schools follow the same strategies as those orphanages and pay parents for their kids to get an education, that’s good, right?

To find the perfect project for myself, I investigated suggestions from my Lonely Planet book. I actually wasn’t all that interested in Thailand: everyone goes to Thailand and in my mind it was overrun by spoiled European teenagers and creepy old white men. Sumatra or Laos or the Philippines… Now those were proper prospects!

The organization that caught my eye, though, was Andaman Discoveries. Their website showed great understanding and commitment to sustainable tourism and fair exchange between locals and visitors. They were locally founded and operated but had a few Western staff members. I took that to mean that they were well in tune with local needs but also easy to communicate with. They just happened to be based in Thailand. That’s where I decided that a smooth experience was more important than trekking unbeaten paths and checked out their projects.

I felt life nudging me when I noticed that one of them was at a special needs school. While I’m not a teacher nor have any sort of official certification (unless a BA in psychology counts), four summers of training and full time hands-on work with children at Austime Quebec does earn me a rank slightly beyond “unskilled”. It’s also a field that I’m passionate about and study extensively in my free time and that, if I do say so myself, I kinda, you know, have a knack for.

I choose to stay for 8 weeks based on my experiences with Austisme Quebec. The day camps I worked at lasted that long, which was perfect. There was enough time to figure out how things worked, to build meaningful connections with the children and other counsellors and to become proficient enough to be able to contribute something worthwhile. And when the intensity of camp became too much and a break was needed, the summer was coming to an end anyway. I figured this would translate well to volunteering at a school so 8 weeks it was.

And that’s how I ended up in Thailand at the Ranong Special Education Center for 8 weeks.

Preparation: Goals

When people write about their unfortunate experiences volunteering abroad, the main problem seems to be unrealistic expectations that are, obviously, not met. Nobody’s life is radically changed, poverty isn’t cured, the houses they build aren’t Western dream homes, they are less qualified for most tasks than local workers and eventually the realization that Western (or rather, developed country) solutions aren’t optimal in other environments slaps them in the face. Then they come home feeling guilty, like they took advantage of someone’s hospitality, caused extra problems and sat around as if watching a freak show.

I think it’s actually not a bad thing that people have felt that way and have talked about it. I just feel that the solution isn’t to boycott or look down on voluntourism (if anything, just discovering that Western solutions aren’t a one-size fits-all makes an experience worthwhile IMO), but rather brainstorm ideas to make volunteer-site relationships more fruitful for everyone.

Having extensive volunteering experience at home and none abroad, I went in with the same mindset I’ve always used: figure it out when I get there. Even when you have a detailed description of what’s expected of you (and usually you don’t), it’s hard to know exactly what you can contribute until you’re personally acquainted with the site or project.

It worked for me. Volunteering abroad was identical to volunteering at home, only with the added spices of the culture shock and language barriers!

On Location: Keeping the Eyes (and the Mind) Open

I think the first and strongest impression I had was this: the school is isolated, but not poor.

The relative meaning of poverty is worthy of its own 2k word blog post so I’ll spare the details, the important thing is that this school would probably more interested in news from the outside world (particularly in the field of special education since new discoveries probably take awhile to be translated into Thai) than in anything concerning basic needs.

Another thing I noticed is how much the school is part of the community. Several times a week, families, students from other schools, radio stations, even military representatives stop by to donate a lunch or a snack and interact with the children. You don’t see that often in Canada and it gets the wheels turning in my head for projects I could suggest at home.

On the more challenging and less rosey side of things, I did feel significantly held back by language barriers and a lack of understanding of what skills Thai children need to develop in order to function well later on in life. Culture shock is worth a post of its own, but for now let’s just say that making myself useful took a lot more soul searching and creative thinking than it would have normally.

And finally, the school had a lot of staff. Like so much staff. The teachers were also extremely competent and much more aware of Thai reality than I so I wondered what I could possibly contribute to this already excellent team.

Concluding: Where Could I Help?

So, Ed and I did the most logical thing: we observed, attempted to make ourselves useful and paid attention to the reactions we got.

I came to the conclusion that there were indeed ways we could contribute, but that they weren’t necessarily what I would have thought of if someone had asked me before the trip what I expected to do in this school in remote Thailand. Here’s an adapted version of what I wrote on my report:

1- New ideas: When we started, the staff asked us for “programs” but because our communication was limited, it ended up being very difficult getting them on board with new ideas. Many of the tools we use in the West inconsistent with Thai reality anyway. In the end, the new ideas that were most successful were simple exercises we could do one-on-one with the children (throwing or rolling balls instead of kicking, hand clapping games, pictograph cards, sorting games, easy art projects). Those activities provided diversity more than revolution, but diversity is still appreciated by those tired of blocks and clay every day!

2- Experience dealing with foreigners: Unless they work in the tourism industry, Ranong-ians rarely get to interact with people from the outside. Meeting people who don’t understand their language or who have unexpected reactions is a life experience they might not obtain otherwise. Staff as well as students can benefit (After all, the whole reason we embark on these trips is to have a foreign culture experience. Most people don’t have that opportunity, so we can bring the experience to them.)

3- English practice: English skills among the staff range from nonexistent to medium. Having English speakers on site allow those who wish to practice and improve their skills to do so. Some of the children want to learn English words as well and those who have the potential to eventually integrate the regular school system will need to know some English.

4- Time: I think this is where we are the most valuable! Even though there is a lot of staff, they are often tied down by paperwork (Thailand loves its paperwork!) or planning, so they all have limited time to give the children. Then, when they are with the children, they have to spread their attention over an entire group. Us volunteers, however, are free to spend an hour practicing a single skill with a child who happens to be in the right state of mind that day. We can afford to be patient with the child who takes several minutes to put on her shoes before lunch. I like to believe that the extra one-on-one time we can give to allow the children to develop given skills can have lasting effects as those children will keep those skills forever.

So whenever I feel like I’m not doing enough or taking advantage of their hospitality, I remind myself of #4 – that I can be useful, not because of my teaching skills, nor because of my foreigner status, nor even because I speak English, but because I’m a volunteer with time on my hands, no objectives to meet and no one demanding my attention. Exactly the same as if I were volunteering back home.

As for concerns about hurting the local economy, I can assure you that the school is fully staffed and that volunteers are a surplus (making #4 possible), that we pay rent and utilities, buy groceries, shop at local stores and eat at local restaurants. I think we are contributing as much to the economy as anyone!

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Visiting the Ngao Waterfall

On Monday, Ed dragged my sleepy behind out of bed (I’ve been having trouble falling asleep lately which leads to tough mornings), made sure I ate and got dressed then ushered me out the door. We biked to school only to notice that there was a clear lack of students.

Turns out it was some kind of planning week, so the students were off until Friday when they’d stop by for a fundraiser/housewarming party.

We tried to help out anyway, but with our very basic Thai, there wasn’t much we could make ourselves useful with. The staff suggested we come back on Thursday to help set up for the party and, being exhausted from the heat and lack of sleep, we thought that was an excellent idea.

Since we’d been planning to visit the Ngao Waterfall and the school is about halfway between our apartment complex and the park, we figured “why not” and biked the several remaining kilometers.

Technically this photo shows us going home, but you get the idea.

Technically this photo shows us going home, but you get the idea.

It took awhile, but the road is flat so it’s not like we’d put in a lot of hard work before we saw the Ngao National park sign.

The entrance fee for foreigners was 100 Baht each (about 3.33USD), which we decided was reasonable (despite the sign looking like it indicated 20 Baht for locals). There aren’t many places nearby for locals to go and explore the great outdoors, so we felt like we were contributing to our host community by visiting the park and paying the foreigner entrance fee.

There are a couple of hiking trails and, of course, the famed Ngao Waterfall.

The waterfall is probably best viewed during rainy season (as you can probably guess, we're deep into dry season here)

I suspect the waterfall is best viewed during rainy season (as you might guess, we’re deep into dry season here)

I did some reading on the park after our visit and found out that there is quite a bit of wildlife (including elephants!!!) residing there, but we weren’t lucky enough to see anything. We also didn’t explore the hiking trails much since we were wearing our school shoes (aka sandals) which really don’t offer much protection from anything looking to nip at us from the ground.

Another thing we didn’t discover until afterwards is that our entry fee includes the nearby hot springs, which we may or may not have been interested in visiting. Both Ed and I enjoy hot springs, but they are less attractive when you’re already on the verge of being ill from overheating. (We got hit by quite the heatwave last week – even I, the heat immune warrior, was a little unsettled by it.)

One thing we did do is get decent pictures of the region.



There are some elevated cabins that I think you can rent for the night, not sure how safe I’d feel in one! The stairs were sturdy to climb so I took the picture above, the one where you can see a wall, from the front porch. It looks like there are some ground cabins too for less adventurous souls.

I dare you to spend the night!

I dare you to spend the night!

So all in all, it’s one of those places that, you know, I wouldn’t specifically come to Ranong for, but being here already, it’s a lovely spot for a picnic, walk in the woods and a relaxing few hours. Or perhaps, if you really enjoy it, a couple of nights.

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Commenting on Pharmacy Errors (post-CBC’s Marketplace Episode)

Judging by the uprising on my (pharmacist-heavy) Facebook feed, it would appear that CBC (that’s the Canadian Broadcasting Corporation- Canada’s state sponsored media) aired an episode of Marketplace about pharmacy errors. It also appears that CBC ran a whole series of news articles, interviews and call in shows to build up anticipation.

I find people’s reactions far more interesting than the material itself, and those kinds of stories really annoy me (and, unlike some, I don’t like to twist knives in my wounds) so, yeah, I’ve read very little and watched nothing of what CBC produced around the topic.

The one article I did read, the one about corporate pressure, suggested that, despite their claim of “months of undercover investigation”, some interns at CBC threw the story together at the last minute upon realizing their deadline was up. The article barely touches on pharmacist working conditions, choosing instead to rehash the Accupril/Accutane error that I swear was covered somewhere else (it is an interesting error, yes, considering one medication comes in a bottle and sits on the “Q” shelf and the other comes in a blister pack and sits over “I”, but it isn’t really relevant enough to the topic of working conditions to be worth half the article). They also choose to quote NPAC‘s statement instead of CPHA‘s, which is a pretty odd choice. (The latter is Canada’s main pharmacists’ association. The former I hadn’t even heard of until the article.)

So, Marketplace. From the reactions, I can’t tell if CBC’s main goal was to piss people off, to instill even more fear in a population already mistrusting of Canadian health care, or to say “Hey, pharmacists make mistakes like every human being. Don’t be afraid to ask questions.”

But anyway, here are my comments on the topics people are talking about.

1- They estimate the number of pharmacy errors in Canada at 50 000 per year, out of 600 million prescriptions filled. I think this was meant to scare people. It translates to a rate of 0.0083% or less than 1 in 10 000. From personal experience, it seems about right (or even a little low for certain settings like nursing home packaging done by hand during rush hour in a busy retail store). Take that as you will.

2- Pharmacist fails to catch drug interaction. Ah yes, drug interactions. Non-pharmacists always assume your two main tasks are counting pills and checking drug interactions. Yeah, they’re important (there always seems to be some lawsuit going on regarding allopurinol and azathioprine given together), but in practice, the number of times you deal with interactions pales to the number of wrong dosings, wrong drugs, irresponsible antibiotic prescribing, duplicate therapy, missing therapy, patients taking drugs incorrectly… If you’re going to talk about pharmacists, at least talk about more than a tiny fraction of what we do.

3- There should indeed be better error tracking. Every hospital, store or company has a way of documenting errors, but there’s nothing standard and central in Canada. We’re still too stuck in the stupid name-and-shame mentality to want to admit to our errors and notify our colleges or boards. Which is unfortunate since, as a new pharmacist, I learned a lot from the fear of repeating other people’s errors, but I only ever heard about them by keeping track of lawsuits.

4- Pharmacists should always counsel when dispensing a new medication or what they suspect is a new medication. The fact that this doesn’t always happen blows my mind. Counselling on a new prescription is a legal requirement (though patients are allowed to decline). I’ve worked in a few stores and I’ve never seen a pharmacist omit this part of prescription filling, but I guess some do. Schedule 2 drugs (“behind the counter”) meds are more of a grey area, but there should always be some kind of pharmacist intervention. If a patient chooses to lie to me because they want iron or Pico-Salax, that’s their problem but it’s still my job to make sure they’re aware of exactly what they’re doing. T1s (Tylenol with codeine) are another story. I follow the rules but I’d love to have you know that it annoys me to no end to be forced to play liver police. (If I wanted to be the main controller of people’s narcotic pain treatment, I would have become a doctor, not a pharmacist.)

5- The public should never feel bad about questioning their pharmacist. I’ve had so many people apologize to me for asking why their medication looked or felt different. I’d shake my head and thank them for questioning me. I’d rather deal with a 1000 false alarms than have a real error ignored. My patients’ health is so much more important than my ego. And on the rare (but not nonexistent) occasion I might make a mistake, questioning may save someone’s life.

6- Retail pharmacy is not Big Pharma and we don’t get free things other than the occasional pen or post-it notepad. There’s even laws against accepting bribes. Perhaps American pharmacists live it up on the backs of drug companies but Canadians certainly don’t!

On Working Conditions

Retail pharmacist working conditions are talked about a lot in the States, but not so much in Canada. Because we’re professionals, pharmacists aren’t protected by labor laws. Which means no obligatory breaks or working hours restrictions. (I think we aren’t even entitled to minimum wage or vacation pay, but those are obviously never an issue.)

If you wonder why you get an angry glare in response to your disapproval of waiting 5 minutes for your prescription, here’s an answer.

Retail pharmacies are usually hectic places. It may not look busy, but trust me, appearances are deceiving. On a typical day, I’d come to work a bit before 9am, put my head down and not look up until I get dizzy around 2pm. Then I’d bring my water bottle and lunch to the desk, put my head down and not look up until 6pm, when I’d remember that my lunch is sitting here. I’d take a few bites then get the closing up stuff done until 8pm. I’d lock the door, then work off the clock until 10pm (though it wasn’t unusual for me to stay until 1am) trying to catch up on reports and documenting.

At any given time, I’ve got 2 lines of the phone ringing, two staff members asking me questions, two to five clients waiting for a prescription, 15 pages of prescriptions waiting for me on the fax machine, a stack of 20 blister packs to check and an emergency prescription to assemble for the nursing home. Somehow, in there, I’m expected to do data entry (every new prescription calls for data entry), check that the prescription is appropriate given your medical history (while you angrily tell me it’s none of my business), track down your doctor to ask if his/her writing of zxy and not xyz was accidental or intentional, package your prescription, tell you about it (despite your insistence that you’re in a hurry), then take your money. Oh, and remember, I need to do this for the two people ahead of you before I can even look at your prescription.

When I tell you it’ll be 5 minutes, the appropriate response should be nothing less than amazement and tears of gratitude. (And perhaps skepticism that I can do it all without making an error because you’d be right – I can’t.)

Still, No Excuses

One of the things I had to learn early on (and relearn again and again) is that there’s nothing more important than patient safety. If I make a mistake because I’m too dizzy to stand straight, it’s not my company’s fault for forbidding lunch breaks. It’s not the patient’s fault for being impatient. It’s my fault. It’s my fault for not having the balls to stand up to my company (what are they going to do, fire me for going to the bathroom?) or to the patient (if they really can’t wait 5 minutes, I should be okay with them moving their prescriptions to a quieter store or to an independent who doesn’t have staff restrictions).

It is easier said than done. However, as hard as I found it to take sanity breaks, whenever I had a panic attack (which happened a lot at the beginning) or a breakdown (which happened pretty regularly), somehow there was always time for me to hide in the back until I calmed down. The key (which I never did perfect) is to know when you should take time out and force yourself to take it before you boil over.

Bottom Line

Your pharmacist shouldn’t make errors and, especially, shouldn’t be making excuses for errors.

However, your pharmacist is human and even the most attentive, knowledgeable, dedicated, efficient, caring, etc pharmacist in the world will make an error at some point. And that error can hurt you. So how about I end this post (rant?) with some tips to protect yourself:

1- As much as possible, always see the same doctor and go to the same pharmacy. So many errors are caused by communication gaps.

2- Never rush your pharmacist. 15 minutes per medication is a reasonable wait time. So if you have 4 medications, budget an hour. But wherever possible, give your pharmacist a day’s notice. Gives them lots of time to get everything ready, order whatever’s missing, communicate with your doctor if needed and so on. Don’t rush through counselling either. Even if you know what you’re taking, most errors are caught during the counselling session.

3- Ask to see the pills before you pay. Showing the pills was standard practice when I worked in British Columbia, but customers gave me funny looks whenever I tried in Alberta. Most of the errors I did make while practicing would have been avoided had I shown the customer their pills before they left.

4- Know what you’re taking and what you’re taking it for. Have your doctor write your medications out for you in legible writing. Have your pharmacist provide a printed list of your medications. Ask for a med review (or whatever your province calls it), your pharmacist will even love you for it (usually we have to force med reviews down people’s throats).

5- Ask questions, questions, questions! Like I said earlier, 1000 false alarms is better than a single incident!

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