women in motion

a book i frequently cite in my research is 'women in motion'. it discusses women's role in labor migration and women's increased involvement in the global trend of work outsourcing and crossing borders to earn money.
one of the things the book talks about is just how easy to is to spot migrant women. specifically, i'm pretty sure she discussed hong kong or singapore, where hoards of migrant women, usually coming from other southeast asian countries, hang out on their days off.
so hong kong, wanders through the streets, and it happens to be the weekend. suddenly, public spaces are filled with non-chinese looking women, who gather around on park benches or on tarps brought from home, sharing snacks they probably made at home, and enjoying their one and only days off. this was amazing; it was like my worlds were colliding and becoming true all at once. these women, probably au pairs or some clothes factories help, are part of a bigger thing, a global market that is only expanding to include more women leaving their homes in hopes of earning some money.
so then, that got me thinking about the business of mail-order brides...because, again, in hong kong you see a lot of these interesting couples of older white dudes and young (and pretty) asian girls. and in my cynical head, i have to wonder if this is what happened, if this is some chick who found a rich white dude while he was sunbathing on an economy (cheap-ass) trip to an exotic asian country. and then, the even more cynical part of me, starts wondering if they are happy, if they got together because they truly fell in love, or just because she needed to get out of poverty and he needed someone to do his laundry...and well, the other thing, we'll leave out of here. from my experiences working with immigrant women, from working with sex workers, this is the only thing that makes sense in my mind--a business arrangement of sorts, where work (and sexual work) are reimbursed with financial stability and security. and then i wonder if these women are geniuses, or really unlucky, to need to resort to marriage arrangements for economic reasons. at least, so it seems, labor migrants are earning their own dollars (or whatever other currency you can think of)....except for stories i heard from my interviews, of women being raped by their employers, whether in the factory or by the daddy whose kid you're nanny-ing. but of course, women are assaulted and abused everywhere. women make bad relationship decisions, stay with abusive partners, all in the name of stability, or money, or some other lie they frequently tell themselves. the circle of globalization is complete.

the inn keeper

if "Les Mis" is now stuck in your head, you're welcome.
i am staying at this rental studio apartment, the inn. the inn keeper is in his 50s. he studied in the soviet union: first year as his language integration, sometime in the early 70s, in Kiev and then in Moscow at MGIMO (Moscow National University of International Relations, by the way, that's super prestigious, then and now, just think Harvard Law). he speaks fluent russian, which is better than his english. he misses kiev and russia, and goes there sometimes, although he hasnt been back to kiev since 2006. he misses russian winters, mostly snow and change of seasons, and hates Saigon weather (that makes two of us), preferring the weather in Hanoi, which is where he is originally from. although the weather in Hanoi is also not ideal: cold wind from china, but no snow.
after graduating from the university with an international finance degree, he worked in various embassies--russia, cuba, peru--before retiring. the inn is decorated with reproductions of famous russian paintings and originals from cuba and latin america: colorful cuban landscapes, beautiful peruvian vistas. sometimes we chat, usually over vietnamese coffee downstairs in the 'lobby'. we talk about the politics in russia, we talk about the economy in vietnam. things have gotten really corrupt, no one wants to work, everyone just wants to sit outside and drink tea.
every time i go out, i get concerns and practical advise. do not walk alone, better to take a cab (that since like overkill). do not take your (giant) purse with you--there are many pickpockets. there is nothing in my bag so very little to pick-pocket, yes, but they dont know that. be careful of bikers, bikers are crazy, do not get on any bikes, even i dont ride them. that's a very good point. he asks me how i like saigon. when i tell him i like the combination of different architectural styles in historical epochs next to each other, traditional asian with colonial french, he responds with 'so such an ugly picture!"
he, his wife, and their child live in the studio on the first floor. the wife is his second wife, and is lovely, although she speaks no english and communicates with me with gestures and google translate. she is my age and leaves fresh flowers in my room--woman's attention to detail. their daughter is adorable, is 19 months old, and definitely has a name...which i cannot reproduce. the girl, when she is not in daycare, watches "Masha and the bear' glued to the screen, sometimes right in front of the screen, sometimes upside down on teh couch. 'masha and the bear' is a russian cartoon about masha, an annoyingly precocious toddler, who makes life of the bear unbearable, but who out of his sheer love for masha tolerates it nonetheless. the cartoon has adult undertones, not creepy ones, but social and political commentary on life, which makes it very enjoyable for adults. in fact, my very adult brother and i watch it together when i visit dallas. when not glued to the screen, the daughter and i are buds: she waves hello and goodbye, shares her morning bread roll, and stirs my coffee, although i'm pretty sure the coffee stirring is simply her way of getting her hands onto things.
the inn keeper has two children who are in irvine, and he travels to the US frequently to visit and hang out. he also has many friends, most of them former college buddies, who have all spent time in the soviet union and speak some proficiency of russian. the tour guide was one of his friends, the other, 'fedya' is another tour guide whose russian is spotless and who talked non-stop for our entire introduction, about the past, their college life, current business, tourism, and whatever else.
somehow the world seems to be a very small place, where one can find familiarity even in southern vietnam. oh, and if you're ever in saigon, stay at the lucky studio apartments.

seid bereit, immer bereit.

so vietnam is a communist country. it is easy to forget with all the selling, buying, and general economic consumerism that surrounds you. but it is, and the communist posters on every street corner serve as a reminder.
i spent yesterday walking around and taking pictures of awkward communist posters. inspired by an idea from my fried Lee, this will become my own homage to 'ostalgie'--let's call it 'far ostalgie'. Ostalgie is a play on words, from 'ost' which means east in german, and nostalgia. it reflects a cultural, social, and emotional sentiment many former East Germans experienced after the reunification. it is not only a feeling, but a cultural phenomenon of collecting everything GDR, and reminiscing about the country that is gone. dont' get me wrong, i am in full support of the fall of the wall, but i can imagine it is hard to wake up and realize that the past 40 years of your life and existence are obsolete ('goodbye, lenin!" is an excellent movie that parodies that).
so back to vietnam. its communism is more subtle. you wouldnt even think it's here, other than the posters. but it's not just the posters. as i mentioned earlier the vietnamese kids wear party neck-ties; they wear party seals on their uniforms. kids go to school on saturdays, but on sundays, parks are filled with party group meetings. kids, teens, and adults fill the park alleys. sitting in the shade, dressed in identical uniforms, like oversized boy-scouts, they discuss and debate party pertinent ideas or topics, i am guessing. some groups make banners, others chant loudly in unison--excited junge Pioniere. and for a second, you feel transformed, somewhere deep into the warsaw pact circa 1985.
the vietnamese elections are in a month, and once in a while a random truck with a banner and a loud speaker will drive down the street, presumably, announcing the election and calling everyone into democratic action for the good of the party. i'm making this up, of course, as shit is being said in vietnamese and i have no idea. but it is interesting to observe: as the shops, stores, adn general life fills with capitalism, banners and political ideology persist, coexist symbiotically with hello kitty, internet cafes, and prada stores.
there is a lot about economics and politics i do not understand, but isnt capitalism the biggest enemy of a socialist state? so how does this work? how is this political ideology working when so many collapsed? an entire region of the world--eastern europe--could not survive, could not overpower the simple human will to have more, or i guess, just to have. so are vietnamese doing something better in allowing the economy to flow, half-dictated and half-driven by market forces? or are people more willing to shut up and put on a party uniform as long as they can go home to their air conditioned privatized apartments while facebooking from their very own commercially produced chinese laptop? adn in that case, does anyone still believe in the slogans or is it all for show, as long as the masses are left alone to eat, drink, and buy freely?
in talking to people here in HCMC, as it turns out, things are not so great. corruption is rampant. the economy resembles Russia of the 1990s, following the fall of teh Soviet Union, where very few became very rich quickly, and maintained a certain control, oligarchy if you will. things function poorly due to corruption and underlying bureaucracy, permeating different levels of society.
for example, young adults flee Hanoi, teh country's capital because, as the seat of the party, competition there is not just academic. for the tight and coveted university spots, regardless of how smart you are, your place may just go to a party offspring, sometimes undeservingly. similarly, with jobs tht are sometimes assigned, given, or bought. the privatization and corruption has translated into the health care as well. universal healthcare coverage means long lines and overworked physicians. an ob/gyn working for a state hospital has 3min per patient. that's 3 minutes per patient's exam, counseling, prescription, questions. as i was told, patients do not ask questions--there is no time. pediatricians, even worse, see 100 patients in half a clinic day--that's less than a minute per patient. sometimes patients are seen/examined as a group. this is all for a physician salary of about $400 a month.
so many physicians are forced to work in private clinics, on weekends, to amke extra money. here, the few who can afford it can buy time, can buy privacy, and essentially better service. the complications rates are, as i am told, lower, patients have time to ask questions. i am not advocating for privatized healthcare system. in fact, practicing in the US, i am more convinced that our current 'privatized' system is deeply flawed. but i wonder where this hybrid of (communist) state and free market economy is going. i can tell you what happens in russia or ukraine or tajikistan. and it sort of works, but only for those who have the means, not, as marx willed, for everyone according to their needs.

walking saigon

i walk around a lot. the city is actually not so big, at least the downtown area, navigation made only difficult by the heat and the traffic.
i start out in the afternoon, after the heat has peaked. this is the time when the outlying city-center streets are filled with white ghosts: white people, ghosting through the city on their ways back to the hotels, sweaty and heat exhausted, in pairs or singular, hostel folk. the more central city is filled with tourists, older couples and couples with kids, french, german of course, adn obnoxious americans. this is also where the shop owners are most aggressive, inviting you to come in and eat, regardless of time of day, pressing menus into your face.
the city navigation makes me angry, so i traverse the city with a permanent RBF, cursing loudly at people on the street. mostly, traffic. tehre is no traffic rules; lights or direction of traffic do not matter, the only rule is go, regardless, of whose right of way it, who is in front of you or what direction you're facing. bikers ride on the sidewalk, with or opposite of traffic, honking loudly at you as if YOU are in their way. this is why, i curse, because fuckers, are on the sidewalk.
similarly, i curse at dudes that offer rides. they hang out on street corners, lounging supine on their bikes and half a block away will scream at you: 'hello madame, motorbike?" some of them are more persistently obnoxious and will continue to talk to you while you're actively ignoring them. 'no, i dont need a bike, asshole! if i did, i'd talk to you'. cursing also flows in the direction of catcalls and obnoxious comments in my direction. inappropriate and totally disgusting, is that how you talk to your sister, are you fucking kidding me?
the parks is where you can sort of escape the heat. the greenery offers protection from the sun and park alleys, away from traffic, are slightly cooler than the streets. the parks are filled with people working out, running slowly around the park, or exercising on the park apparatus(es??)--these exercise machines, metal, like ellipticals and bikes--all in street clothes. there are group classes--dance, aerobics, martial arts of sorts--one can take for free. the park alleys are lined for badminton; alleys are filled with people playing vietnamese hackey-sac: same idea i think but the hackey-sac resembles a shuttle-cock. park benches are filled with old folk, couples, adn groups of vietnamese youth attacking foreigners. i'm not sure if these are organized or if white people are simply accosted on street corners and are asked to participate in political debates or general english language practice. parks are also where pictures are taken: leaning against a tree, staring into the sunset, looking at a leaf. this is where match.com vietnam happens. on weekends, parks are used for party group team meetings (more on that later).
the sidewalks are filled, at all times, with parked bikes, vendors, people sitting and eating, or just sitting. somtimes it seems the entire city is just hanging out on the sidewalk. there are chickens on the street, belonging to vendors, and it's unclear if they are pets or tonight's dinner. there are cafes that have all of their seating outside on tiny little plastic chairs, or just cart vendors that park on whatever tiny area of sidewalk they can claim. this makes the sidewalk impassable, forcing one (me) to navigate between bikes, carts, people, hanging feet, and stepping into traffic. it's all about magical thinking because no one moves over, ever. large trees and sidewalk cracks frequently have little incents and buddha offerings of food and coffee, presumably, for good business.
ignoring the heat and the anger provoking traffic, the city is quite beautiful. old colonial buildings meet traditional asian architecture in an seamless blend. the city is living, moving, exhaust-ing, cooking, eating. it is green, it is loud and sweaty, obnoxiously forcing itself into your face.

emergency contraception

journal club take 2, and based on popular demand, we are discussing emergency contraception. a 1st and 3rd year residents were supposed to present together, but the 3rd year got busy with something likely more clinically important and could not make it, so the 1st year is left on her own.
it is hot. the room is filled with people all eager to listen, and the ceiling fans are not doing a great job of moving the hot air around. the resident goes through the PowerPoint, then it's question time. the professor (of reproductive medicine) is there again. he asks very specific pimping questions, with theory and mechanisms thrown in. the resident keeps redirecting questions to me, referring to me as Miss ALex. Miss Alex? who the fuck is miss alex? what is this the miss muffett's story hour? you can at least settle on dr. alex! i am, of course, sweating: it is uncannily hot, too hot to think, and all i can think of is slowing down my metabolism and breathing in futile hopes of sweating less.
the first problem is clinical practice: what is used in the US as emergency contraception is different. so while plan b (progestin-based contraception) is available in Vietnam, it is apparently way more expensive than Mifepristone (also known as 'the abortion pill', which in the US can only be dispensed by specially licensed physicians, whereas here you can buy it in the pharmacy). so while i can speak of efficacy and dosing, practically speaking all these questions of use, or even more important theoretical discussions of prostaglandin paracrine effects (yes, we got into that too) is useless because that's not our practice.
then i am asked why women in the US continue to use emergency contraception, adn i am faced with the dilemma of explaining to my culturally and socially conservative audience about prevalence of one-night stands, drunken mistakes, or american dude's dumb inability to put on a condom. the truth is, i dont know. the truth is it is not always drunken hook ups, it is sometimes very responsible contraceptive failure, like forgetting to take a singular pill, or the condom actually breaking. sometimes, it is on again, off again boyfriends; it abusive and coercive partnerships, it is difficulty in getting to one's doctor on time. there is no singular answer. so why, then, despite the ability to buy plan b without the prescription (yes, at someone high price) and even more effective Ella (yes, at even higher price), the unintended pregnancy rate in teh US remains so high? why dont patients take plan b if/when needed but turn to pregnancy termination, the rates of which, also, remain so high? are we as physicians not doing a great job telling women about this emergency contraception thing? or, better yet, are we doing a shitty job contracepting women in the first place? and while as a family planner i fully believe that long-acting reversible contraception is the best-est ever, i cannot place a device in the uterine cavity without my patient's consent. nor can i show up at her house every morning to remind her to take a pill, or stalk her at a bar and remind her to put on a condom. i guess what we can do is continue to remind our patients that emergency contraception does exist, in cases of those unanticipated trysts, OKCupid dates taht have gone too great, or in cases of abuse and domestic violence.
alright, i will get off my soap box. the horse is dead, its beaten body is now rotting in the sweltering heat.

night shift

this may get a bit detailed and graphic, so i apologize in advance for shop-talk.
I am invited to go to labor and delivery with Dr. Huy (i'm pretty certain he has taken pity on my boredom here). He is working the night shift, and I tag along. I arrive at 5p, and we change into scrubs (his—hospital issued, mine—brought from home). I am asked to change my dansko OR shoes into flip flops. This seems sanitary. Then, we tour the unit.
There are two labor rooms: a large room with cots lined along the wall, where women labor in the latent phase. After 4cm dilation, they are moved in the active area. This is set up as a semi-circular room, like a circus arena, with 6 open room on the periphery of the circle, each with two delivery cots. The nursing desk is in the center and this is where nurses chart in paper charts. There are cabinets with medication: misoprostol, vasopressin, nifedipine. One or two infant scales sit in the corner, but no more. Women are brought in, sometimes two to a room. When it is time to deliver, nurses check and deliver patients, with resident or physician assistance as needed.
In the active phase, women labor on continuous monitor; in the latent room, if there are no strip issues, the monitor is applied q2-4hrs. while a woman is delivering quietly, with nursing assistance, another one is climbing out of her cot, laboring un-anesthetized in the cot next to her. I look at the strip and she is banging out contractions every minute. I hold her hand and try to breath with her through contractions, which is, of course, difficult since I do not know how to say breath in Vietnamese.
Following delivery, women are moved into the recovery room for 2-4hours. Sometimes, when the recovery room is full that means they are moved out into the hallway. Infants remain on mother’s chests, inside their shirts for warmth.
Some overly excited (male) medical students decides to ask me questions. How long am I hear, who am I learning from? Learning from??! What specialty are you going into. I am an ob/gyn, as in I am a practicing physician ob/gyn. Oh, I thought you were a med student. Nope, and fuck off, buddy.
Then, I am offered to deliver a baby. There is a lot of plastic and cloth going on underneath the patient, who is laboring with her gown raised, no sheet. I have an audience of about 8 people, all gathered around to watch the weird girl try to deliver a baby. As the head is about to crown, the resident who is there to assist me cuts a giant mediolateral episiotomy as I cringe in my mask. I delivered without problems, and apparently everyone is amazed that someone so young (me) has such great skill. The infant is placed immediately on the belly, cord attached, and although it is great for such swift skin-to-skin, I am pretty certain it is because there is nowhere else for the kid to go. I try to clamp the cord, which apparently is always delayed clamped, again, not because of the believed benefit, but probably because no one actually rushes to do it. I try to clamp the cord but have a hard time reaching the kid’s belly, so clamp sort of long, thinking they can always cut it later. There is commotion, apparently, I just committed a faux-pa of sorts as the cord needs to be 3cm long. I am given another clamp, great. Finally, cord detached, I deliver the placenta, with a giant rope of a cord hanging down. A sterile sheet is placed supra-pubicly just for me because, apparently, no one does maneuvers to deliver the placenta. I ask if they ever run Pitocin. Oh yes, it is running, I am reassured. I look at the line and it is half closed, so yes, Pitocin is very slowly dripping, not the same. Once the placenta is out, the woman’s perineum is watered with water out of a teapot and drenched with betadine. Do you always cut episiotomies? No, only in nullips (first time pregnancy) and with prior C-sections. So the answer is really yes. Now, in the US we never cut episiotomies because it doesn’t make a difference in delivery complications, and I briefly contemplate sending the doctor an article about increased rates of complications with episiotomies, but decide it is somewhat passive aggressive. Before I get a chance to repair the gaping epis, I am whisked away to do a c-section.
We walk into the operating room, the patient is on the table, arms out, gown up. I ask what the indication for the surgery is, apparently, it’s big fat baby syndrome, also known as macrosomia. As the nurses prepare charts and things, an anesthesiologist walks in and places spinal anesthesia, which means that the patient was just splayed out for now reason. No monitor is attached; the physician looks at the chart, but doesn’t talk to the patient. Finally, we are ready to scrub. After gowning, one of the residents arranges instruments. I was worried about not being able to call for instruments, since I do no know their names in vietnamese, well, turns out it doesn’t matter because there is no scrub tech: you reach for your own instruments. The resident is super helpful: she wants to do residency in the US and has already taken her STEPs (I’m pretty sure she did better than me when I took STEP I in 2007. God, I’m old), so she speaks english. We are not using electrocautery (to coagulate vessels and stop bleeding); I frantically search the instrument tray for a Kelly (a clamp to clamp down on vessels to stop the bleeding) and there are none. Ok, so we just wont cut into vessels, that’s totally fine. And there are only about 8 laps…ok, we just won’t bleed at all then.
We start, or rather I start, and it goes smoothly. We get the baby out, and this is where things get confusing. There is some confusion in the process; they do things a bit differently, so i feel like i'm messing up because i am not quite sure what it is that they want me to do, since we do it differently. I feel like Dr. Huy is sweating watching me fuck up. I make a joke about him sweating in nervousness, and the resident laughs…he does not. I am wearing flip flops and I am completely convinced that my right big toe is squashing in a puddle of flip flop contained blood. finally, we are done. After surgery, I unscrub and suddenly the nurses, in a very animated fashion, tell me to take off my flip flops because they are bloody. You want me to take them off, and be barefoot in the OR, is this what oyu’re telling me to do? no, apparently, there is another flip flop pair in the corner and I walk barefoot to change into that. I examine my foot: no blood. Magically, I did not make a mess.
We return to the labor room. It is relatively quiet, only two women: one delivered, one soon to be. I hang out a bit longer, the resident asks many questions about residency. It’s getting late, so I piece out. I think I’ve sufficiently embarrassed myself for today. Two babies, both boys, both Vietnamese.

a wedding and a funeral

apparently, i have an uncanny ability to crash weddings in foreign countries. i am invited to the wedding of the head department's former students. we arrive at the venue and are immediately greeted by bride and groom, pictures are taken. we are lead into the reception area where tables are set up: white flowers as centerpieces, lime green ribbons tied to chairs. The stages is set up with white and magenta flowers. There is a tower of martini glasses on the left, giant 5 tier white cake with cascading purple flowers. the back curtain has the bride and grooms names and the date, back lit in magenta.
we are seated at a table with two other residents. many questions are asked about my (non-existent) husband; i have to convince everyone that i am my age adn not in my twenties. then, i am encouraged to go around and talk to people, because i am such a distinguished guest. that's weird because i dont know anyone. a woman walks up on stage and starts singing in this amazing beautiful voice. about a minute in, someone asks if i understand what she is singing because, apparently, she is belting out celine dion in english, and no i have no idea (but crazy amazing voice). then, the wedding party arrives. first the parents, ushered in by boys (well, men but they look 13) dressed as nutcrackers (or bellhops) and girls (women) in long white dresses. i try to ask who those people are but my questions are misunderstood. then, the bride and groom. everyone lines up on stage; the MC says some things. a hot chick in a LBD reads a letter the bride supposedly wrote for the groom (the groom is sort of not listening). glasses of rose champaign are offered to parents, in sequence, which they drink together. then, the cake is sliced; the nitrogen is placed in the glass tower and same rose is poured over creating a fog cascade. everything is paused adn posed for photographs.
then the food arrives. i mention no meat for me. are you vegetarian? you didnt tell me earlier! i feel terrible, i feel like a traitor who had just sold top secrets to the KGB and betrayed the country. but the kitchen will make me a vegetarian thing, whcih arrives 20 minutes later: zucchini flowers, spring onion, and oyster mushrooms atop noodly noodles (to quote my friend Mo). totally vegetarian, except for pieces of ham carelessly tossed in, which i carefully extricate. i am also immediately handed fork and spoon because i am white adn not to be trusted with chopsticks. sad day. after my noodles, which are way to big to finish, meat that looks like beef but smells like pork in stew form arrives with bread rolls. i am to dip my bread roll (without stew) into soy sauce. the bread tastes oddly as if it was basted with condensed milk but soy sauce makes everything better. then hot pot for hte rest, and i am handed another soup. no, wait, not soup it's dessert: tofu in lychee syrup.
throughout dinner people are getting up on stage to sing. apparently, everyone in vietnam is an american idol contestant. i am asked to go up and sing as well, as a wedding gift. absolutely not, that would be a terrible gift. we go around the table a couple of times to discuss that i am, in fact, older than 23. the bride and groom come over a few times to toast (i am toasting wiht water); at some point, the bride stops by adn is offered a bowl of hot pot (she has not eaten yet), and because everyone else is sitting i hold the bouquet. everyone is amazingly sober, most importantly, me. and after dinner we make our way out.
now we are headed to the funeral. is it ok taht it's so late? yes, the family will stay up all night, so we can come late. is it ok that i am dressed like this? yes, you are a foreigner, you dont know. we drive throuhg the city to find the street where the 'shiva' for lack of a better word is held. the street corner is marked with a flag; same flag is atop the house where the family lives. the funeral is held in the courtyard. the family, dressed in white robes, hospital gown style, and white head bands, greets everyone and offers them drinks. there are funeral wreaths at the door, white and purple flowers. the air smells like incense and jasmine flowers. the family sits around with us at a table. the man who died was 84. his grandson went to school in england and is helping translate. he apologizes for the randomness of me being there. no, i'm sorry for your loss. dont be, he was old and ill, it is better this way. but grandma, who is handling this well right now, may not be ok. so they talk about giving her medication, benzos, to help calm her down. after settling on a med that wouldnt interfere with her hypertensive meds, someone is dispatched to the pharmacy.
i ask some questions about tradition, although it seems weird to ask questions at a funeral. the family will mourn until wednesday, when the body will be cremated. the length is prescribed by the monk who looks into multiple things to come up with the number of days. then, we head upstairs to pay respects. i stand towards the back as bows are offered to buddha first so he may hear, and then to the photograph of the deceased to pay respect. cupboards are covered in newspaper. apparently, buddhists, like the jews, cover their mirrors when there is a death.
we head out, driving through the night city. there are a ton of people out on teh streets; the streets are lit up; traffic moves all around crazy-style. the city is alive.

up the river

today, we took a day trip up the mekong river. i was excited not just about the trip, but internally had this whole retracing apocalypse now... it was not quite like that.
i am going on this trip with the other guests staying at the hotel: husband (tall black british dude), wife (short vietnamese-british lady), and their daughter (about 15 and typically for her age, pissed to be there). our tour guide--a tall vietnamese gentleman, with dyed black hair, false top dentures that move when he talks, and perfectly straight charcoal drawn eyebrows--speaks english, russian, and german, which covers all my bases. he is a journalist and used to work for the foreign ministry. he intermittently comes up to me to tell me i am handsome. there is some debate as to whether i should be wearing sandals. now, i'm dressed pretty much for the beach because we are taking a boat up the river and i have a feeling the boat my flip over (the wife is wearing a business dress and pearls, so there is clearly some discrepancy), but i decide to go with the initial instinct to rock flip flops. "so typical american" according to the british dude. well, buddy, we'll see who is faster when we have to swim to shore.
we drive off, air-conditioned van and make a stop at a local shop where tea, snacks, and weasel coffee (look it up) is served. as it turns out, we are there to buy things, with a discount. people keep asking me, where is your husband? i dont have a husband. you single?--the tour guide starts clapping, the british guy dies laughing. on the road, we pass rice fields and get a history of saigon and all sorts of population facts (population of saigon is 11 million, there are 6 million motor bikes). now, the guide speaks english, the problem is he is not very good at it, and interjects many not english words, so prepositions, verbs, and sometimes nouns come out in russian, in one flow of a sentence, which obviously to others do not make sense. he also is hard of hearing, so many of my questions are simply ignored.
enter a beautiful buddhist temple. there are three huge buddhas outside: standing, sitting, sleeping (sleeping buddhas are very rare, the biggest one is in dushanbe). we walk into the temple and are made to pray (british guy refuses, so i am named captain of the team). as we light incense and bow, we are to dream a dream, 'like a good husband or all the things like that'. the guide is unbelievably loud, with his explanation and commands, in this peaceful subdued place, and i apologetically keep looking at the monk striking the gong.
we reach the river. how far up the river are we going? that information is classified, sergeant. there is a motor boat that will take us there. we are going up the river, into the jungle, or more specifically, one of the islands. there are five--the island of dragon, unicorn, phoenix, tortoise...and the fifth one--we're headed for the unicorn. the first stop is a cocnut candy shop, or rather a coconut candy hut. coconut candy is delicious and can be bought fresh. then, we are excorted towards the back, where multiple little rickshaw/carts are attache to small horses. i am about to pet one, when i am told to get in. oh, apparently we are going on a my little pony ride. the lady driver scoots me away from the front, and midway through the trot, my little pony starts to poop, large caliber turds protruding from its anus. maybe this is why the lady made me move. my little pony is forced into a trot and i feel horrible as this thing must be dying. bcak to the boat.
next, we pull up at a restaurant, or a giant hut--lunchtime. how long have you been a vegetarian? 16 years. huh, i always thought vegetarians were skinny. thanks, british dude, for just calling me fat.the menu is prefixed, which we are not aware of, so the wife (who speaks vietnamese, because...she is vietnamese) orders more food in efforts to avoid me starving. the result? a shit-ton of food arrives. oh boy. there are other big tour groups around, russians, chinese. after attempting to make some progress in the huge table spread we call it quits. back in the boat. the boat takes us to the next stop--a village where souvenirs are sold. this is a tourist trap. never get off the boat. there, we are offered fruit and tea (didnt we just eat?!) adn women in yellow traditional dresses sing songs for us. like the playboy bunnies, minus the chopper adn the stage. then, we are led through a garden, where there is a lesson in agriculture. this is a mango tree, this is a coconut tree, to drink not to eat. in the back, there is a canoe, which we are taking through a canal. beautiful ride through the palm forest, although we first had to navigate a complete boat road block. now, i am sweating as we are in peak heat, the guide's eyebrows remain intact, no running, flawless.
back in the boat, coconuts are waiting to drink on the ride back.
and we're off in the van to home. we talk about US politics, and the healthcare system. the guide, closes his eyes when speaking, and when asked questions, would prop up and recit soccer facts. the manchester city is the number one football team in britain...didn't you ask him about popular locations in hanoi? he has a conversation wiht himself. entering the city, we hear the same facts, population of saigon is 11 million people. we have come full circle.

journal club

Today, as my goal for this trip requires, I am presiding over journal club. Now to me, journal club means sitting around discussing the good, the bad, and the ugly of some particular research article and figuring out what the authors did wrong. In Vietnam, journal club, apparently means a whole formal PowerPoint presentations thing.
I offer to meet with the resident who is presenting the article before her presentation. We meet in the office, it is hot. The windows are draped with heavy green curtains to keep the sun, the hot air, and any air for that matter out. I think i might actually die, in this tiny little room on the fourth floor of this vietnamese hospital (the fourth floor is a misnomer: the first is the ground floor, then there is a pho-floor, then the counting starts with 1st floor, so i htink i climbed like 6 just to get here). air conditioner is turned on, but it's really not doing a whole lot. we go over the presentation and the resident went way above and beyond anything I would have done, adding molecules and things. We still have some time, so we head downstairs to grab lunch.
The hospital cafeteria is semi-outside and is similarly hot. what happens in the summer? does it get hotter? oh yes, it does. that's impossible; it is simply impossible for it to get hotter. we sit in the main area--milk coffee for me, soup for the resident. at some point some chick (a patient) tries to beat another chick (pregnant patient), but the fight is separated just in time. then, head back upstairs. I ask many questions about residency. Ob/gyn residency is 3 years; the schedules are less crazy than the US resident schedules (more like 8-5), but they do take night call, which apparently you're scheduled for once a week (and get half day off), but also, residents volunteer to take call and stay longer to 'learn adn practice'. damn, i'm not that motivated.
some boy (pharmacy student) is enlisted to rig up the projector. at presentation time, an older wiry dude shows up introduces himself and before i get a chance to tell him who i am, he launches into a whole life-story. he is the vice chair of the department, adn for hte past 20 years he has been involved in reproductive health, 16 of which he spent in infertility work. umm...i'm alex? then, he proceeds to tell me all about the curriculum reform they are launching in med school and proceeds to pimp me! (WTF?) about curriculum in my institution and whether we use team-based learning (ok, it's been a while since i've been in med school and i honestly, have no recollection). then, people come and presentation starts.
The vice chair takes the mic adn formally introduces himself (wait, you just told me who you are), then formally introduces me and hands me the mic. damnit! then, the presentation finally beins. The resident does an excellent job reading from the slides. but the discussion becomes very formal. I am asked to speak my opinion (mic in hand); my poor resident gets pimped..2 hours later we are still beating the horse. other people come up with questions. there is a resident who asks about how ot tell what the first day of menstrual period is in someone who just had a medical abortion where she is pregnant again. 1) this woman has no business being pregnant again, 2) you did a shitty job making sure she does not get pregnant again, 3) you always have ultrasound. then, there is question boy, who is really hung up on molar pregnancy and asks like 3 different questions about it. the horse is dying in the heat. but, actually, i'm having great time. we talk about regimens, and medications, and contraception, and contra-indications. i ask what else they want to learn about and we come with a next week topic (emergency contraception). finally, class is dismissed. the helpful male doctor came too, adn he asks me if i'm taking a cab home. no, i'll just walk. walk?? but it's so hot outside?! yes, yes it is.

Day 1, or token white girl goes to cinic

I show up to clinic at 8 am like I was told last week. I climb five flights of a staircase lined with bodies in various degrees of wakefulness. The clinic waiting room is already super crowded. I walk past the reception into the clinic area; it already smells like products of conception. I walk up to the nurse sitting in the hallway, and ask for her boss. The nurse scurries away, then returns and drags me to a different doctor-looking person, presumably understanding English. Now, this is my fault because I entirely should have anticipated what followed.
I am asked who I am. I am a doctor, from America, I spoke with your boss…..of course I don’t remember her name, and she told me to come here today…and it is today. Another (male) doctor is summoned, they take out cell phones, start calling people, then I am dragged into the back of the clinic, where another doctor is summoned. The three of them proceed to have a conversation, the third doctor does not seem pleased. I am escorted back to room one. What is the purpose of your trip? I am here to work and to observe. More conversation; the entire staff is now out, staring at this spectacle, ie me. eventually, I am escorted back into a locker room. You can change your clothes. Do you mean into surgery clothes? No just white coat. Oh, I certainly don’t need a locker room for that. I put on my white coat and we walk back into the clinic room. You will observe me examine patients? Sure, that’s all I ask.
The clinic room is about 8x20, separated in the middle by a large column, with US and blood draw area in the back, separated by a plastic half-wall. There is a desk on one side, another on the other, plastic fold out chairs behind the desk. The two doctors sit behind the desk, they pull a chair for me and make me sit in it. The patients come in randomly. There are plastic stools (about 5) lining the wall, which is where they wait. Each patient carries her own chart—paper with handwritten notes on history, payment stubs, number in line (DMV style)—all handwritten and stapled together. There is a nurse who sits at the side of the desk and takes the charts from women's hands and places them in the corner of the desk, from which they are taken. This whole clinic operation, the clinic itself, functions like triage: women are seen for terminations, for consultations with questions of weirdo bleeding, for procedure follow up. They enter the room, whenever, and line the walls sitting or standing until their chart is pulled from the pile. There is no privacy, there is no HIPAA. Conversations, counseling, discussions of medical histories happen outloud, with everyone listening.
Doctors take the chart, calls the name of the patient, who then moves to the chair across the desk. Ultrasounds are reviewed, notes are scribbled and labs are recommended, after which the doctor pulls some sheet of paper, writes her orders and passes it along to the nurse, who fills the rest (patient’s name, birth year) and explains to patient where to go. Cross-conversations happen all the time: doctors are talking this way, while the nurse is talking about something with a different person sitting at the desk that way. Everyone's paper is stamped—tehre are about 5 different stamps on the desk--blue and red—and the nurse staples all of it together.
I feel like I’m on display, sitting at this desk with everyone walking in (or passing by, for that matter) staring confusingly at me. yes I stand out, I am aware. The room is crowded. At one point I counted 12 patients just hanging out along the wall, waiting to be called. This is including 2 doctors, 1 nurse, big ole’ me, and about 7 different nurses and ultrasound techs hanging out behind the desk waiting on patients. Everything is in Vietnamese. The young doctor, who is a resident (confirmed later, she has 6 more months left of residency) intermittently explains things about patients, but they are too busy and I feel bad taking their time. I piece information together largely by ultrasounds, figure out what patient are here based on grainy and poorly taken pictures (I would have made my residents redo the ultrasound). Super tiny early pregnancy, tiny slightly older pregnancy, thin uterine stripes of follow up. A 68 year old diabetic woman shows up because she has had an IUD for the last 20 years and wants it out. (This is way big to do about nothing, if you ask me), but she is sent to the lab for blood sugar check and then likely hospital…because she is 68. Another woman walks out of ultrasound crying: she has an embryonic demise--fetus with no heart beat. Another woman has thyroid cancer and is undergoing chemotherapy—freshly keloid scar across her neck, shut voice—her 18 week fetus has no heartbeat. One woman is turned away: she is 23 weeks, Vietnam allows termination up to 22. Patients who are admitted to the hospital get a blue chart; procedure charts are green, both are started at the desk. It is hard to tell if patients are being counseled—medical versus surgical termination—or just told what is happening. It is all in Vietnamese.
By 11a my doctor friend gets up and disappear, two more patients to see. Then, she comes back to tell me that she is working the night shift and because of that gets to go home half day to rest. If I’d like, she’ll take me to lunch. We walk outside. Do you eat Vietnamese food. Yes, but no meat, no fish, no street food. Oh, you’re vegetarian---dumbfounded look. Do you eat bread? Yes, but I’d prefer not to. She takes me to a ‘nicer’ looking café. After scrolling through the menu, together, nothing is vegetable friendly other than a pot of vegetables, so a waitress is summoned. She suggest french fries… umm, maybe I’ll just have thing yogurt thing. My companion orders the same, I think, because she feels bad. As it turns out I basically order dessert: soupy yogurt with crushed ice, whipped cream, pieces of strawberry on the bottom. My companion fears I will be hungry; I fear SHE will be hungry. We talk shop, medical practice while eating. Then head out, I thank her for her help and company, and then realize—I’ve just eaten ice. Shit!
So one redeeming doctor things I did today was help talk to this young Spanish girl who is traveling through southeast asia and just found out she was pregnant. she is too early in the pregnancy, and the ultrasound could not see the pregnancy. So I have to explain to her that we cannot do her abortion until we see the pregnancy in the uterus, until we make sure it is normal, otherwise, it can be somewhere else and not normal, and that would require a whole different set of meds. She is on a visa which expires, she has plans to travel the country before she leaves, she is now sobbing. I try to tell her not to worry. That if she can change her plans, she should come back in one week and we’ll take care of her then. Then, I ask her where she is going. It’s ok, if something happens, we’ll take care of you in Thailand. I hand her my email address and tell her to email me with questions. I tell her not to worry. I hope she feels better. I mainly feel bad because I can see myself, ten years ago in my travel days, suddenly being pregnant in a foreign country. I would have flown directly home, and I admire her for the courage to walk into a mess of a clinic, in a foreign country to take care of a very unintended mistimed pregnancy.

the war remnant museum

which is where i went today. everyone told me to go, and it was interesting in that it portrayed the war from the local perspective. and it was good and introspective in that regard. but here are a few things which i found uncomfortable...not like upsetting because it is disturbing (the only really disturbing part i actually had to walk out of was the prisoner/torture part), but more like eh this is not how i would do this museum part.
so there is a lot of stuff on international anti-war support which was cool, and some historical facts and strategical involvement part. but the issue is vietnam remains a socialist country. there are party flags all around the city (at first, i was confused why there are all these almost soviet flags, with hammer and sickle, around the city, but i think it's just the party flag). children wear young pioneer neck ties, red like in the soviet union, not blue like in GDR. so some of the information read a bit propaganda-esque, and i think there is an actual reason for that.
the other thing is that some of the information/commentary seemed to forget that this was a political conflict. not to downplay the US involvement: i fully believe that this was not our conflict, and we had a lot of political AND economic interest, and we did a lot of shitty shitty things to many civilians, but there was a greater political context to this. other parties were involved, and while the museum did mention, casually at some point, the number of guns supplied by china and the soviet union to the north, and while i doubt the chinese or the russians were committing atrocities, still this was a bigger thing. and because i am generally obsessed with 20th century history, and specifically, with the politics of the 60s, this to me seemed odd. and war is war, terrible and unnecessary, but any war is war. and showing pictures of bombed out factories just to show 'look how bad things got' seemed redundant. i mean, of course, factories will be bombed, in any armed conflict, right?
the other thing that was less palatable was the excess of pathos when discussing war 'casualties'. again, i think the amount of civilian badness that the US committed is inexcusable and absolutely terrible. but it was portrayed in, maybe, a slightly over-dramatic way. there was a room dedicated to victims of chemical orange, and it was literally a wall of pictures of people with handicaps and deformities with inscriptions like "this newborn is deformed because it was born to parents exposed to agent orange, how will it start its life??" "this girl is mentally retarded because her parents were exposed to agent orange, she spends her day in a cage where her parents put her." (wait, what??) "this newborn has anencephaly and it died a few hours after it was born because its parents were exposed to agent orange" (anencephaly is not so uncommon chromosomal abnormality, and can be caused, among other things, things like lack of folic acid or advanced maternal age, so causality here is less clear to me, from a professional stand point). yes, dioxin is terrible, yes we poured tons of bad shit on a lot of people, yes the pictures are powerful and profound, but maybe overly so?
and of course, as any museum, it was full of tourists, with complete and total lack of personal space manners, who would eagerly try to read the inscriptions even though i am already standing perfectly right in front of it. and then being super obnoxious and taking pictures next to museum exhibits and posing, smilingly, with the war aircraft outside. yeah, that's tacky.

conferencing

day 2. i attend a CME (that's continued medical education) conference. it is on HPV and update on CIN guidelines, is meant for physicians from other hospitals/regions, and is entirely in Vietnamese.
One of the FP doctors picks me up in the morning to take me to the university, which is further away then the hospital. he is 15 minutes late. he is supposed to be taking me on his bike (dont tell my boss), but my landlord who was keeping me company while waiting, strategically talks him out of it and suggests we better take a cab (cassing should thank him). we arrive at the conference already in progress, and since no one wants to sit upfront, we park in the second row.
the conference is in the medical university. the conference room itself seems oddly familiar, like i've seen it somewhere before, maybe at a conference in russia, maybe somewhere in east berlin. the conference room is old, built likely right after the war, maybe even before. the walls used to be beige with pink splatter; they are now gray with some pink peeking through. concrete floor, linoleum stage, red velvet curtain behind the screen. giant bust of ho chi minh sitting at upstage right. there are red banners with ho chi minh quotes (i assume they are his because the quotes are signed with his name); no a/c whirring fans over rows of wooden conference chairs.
i am learning all about pap smears, and how the ThinPrep has a higher sensitivity. the slides and the lecture, of course, is all in vietnamese. i understand vietnamese! wait, no, i can just piece together numbers and no the guidelines. the male doctor intermittently tells me what is being said. at some point, he tells me he has to go back to the hospital and pawns me on a resident (3rd years, 3rd out of 3).
we take a walk around the university building, with medical students sitting in groups on the floor (sweaters, no shoes). we stop short before the anatomy lab ("are you afraid of anatomy?" "no, but it's been a really long time since i've taken anatomy") apparently, it's the biggest in the nation, unclear why, other than they have a lot of bodies there.
back to the conference. i am introduced to more residents. some confusion happens at first as they realize i (the visiting professor) am not an old gray dude, and am in fact "quite young and beautiful" (this is immediately followed with 'are oyu married?"). i am force-fed raisins, i guess i have to work on my asian no. we listen to more guidelines and protocols. one of the residents keeps asking me questions about our practice, which i sort of feel like i'm not always certain and certainly dont want her to think i'm stupid and/or lying to her. although, apparently, in vietnam they follow ACOG guidelines. after the last speaker, a terrible thing happens: the faculty and residents take pictures, on stage, and drag me with them. so there i am, front and center, at a random vietnamese CME conference. then the residents have a meeting and i am asked to please wait a little. the meeting mainly consists, as it seems, of the residents being yelled at. good to know some things are not all that different. then, i am quickly escorted into a cab. super productive day!

jet lag

actually, after taking a ridiculously long flight, i'm not really jet lagged. i did get like two hours of sleep after figuring out the noise situation (the window faces a street, and although there are no chickens/roosters across the street, at least not the ones that makes noise, there is plenty of honking noise), then headed out to work.
first thoughts: it is hot. really hot. i'm not even sure if i'm more distressed about the heat here or when i was in tajikistan. oh, who am i kidding, it doesnt matter because it is hot. technically, the temperature in HCMC is lower than in Dushanbe, but the humidity is killer. I am sweating, profusely. i feel as ridiculous as i look. amazingly, of course, the vietnamese apparently are not bothered. in fact, they wear jeans and sweaters, like actual sweaters, stockings in their sandals, and i am the crazy white girl barely making it down the street. i got lost looking for the right building. well, i didnt get lost, i just could not find the right building. found the hospital and the map of all the buildings, but, let's say it was not true to scale. so i arrived at the head of the department's office, after a significant amount of wandering around, completely disheveled.
next, everything is in vietnamese, which obviously makes sense, but makes it incredibly difficult to find anything. i stood in the soy sauce isle for like 15 minutes staring at the soy sauces, trying to figure out if it's really soy sauce or if they're trying to trick me into buying fish sauce. because none of the bottles had any indication what was in them, well, not in not vietnamese. ok, maybe that story also approves that i'm neurotic, but it's the similar situation with spoken words. whenever someone tells me to go check something out, the tonality of the spoken word makes it impossible to understand or even visualize what is being said. and street names. i swear they all begin with ngyuen and have a different combination of other words in them, which sounds terribly culturally insensitive, but makes it hard to walk around the city without an actual map.
the other thing that makes it hard is stupid traffic. it is unreal. the amount of motorcycles, cars, bikes, mopeds, whatever that moves as one, in different directions, right or wrong, and across is terrifying. crossing the street is a feat and requires a great amount of magical thinking in firmly believing that you will not die and must step out and walk with purpose while the traffic spreads around you like seas around moses. the problem is once you've mastered that, thinking that the sidewalk is your safe place, you're wrong: the fuckers drive on the sidewalk! come up behind you, completely startling. i am terribly jumpy, feeling very ptsd. the drivers and the passengers behind them wear face masks. some plain blue surgical ones, others personalized fashionable ones with patterns, stripes, curious george. some of them are strictly face masks; others extend into these elaborate neck and head covering, like a jihhadist's uniform. they also wear full on gloves and sleeves, so i initially thought the masks were for dust protection, but given the neck covering, i think it's more of a sunscreen thing, since one's neck in not that likely to get dusty (although what do i know). and that again makes it more fascinating: as i'm sweating my way through the city, wondering how i can minimize my clothing more, the locals are covering up, head to toe, before getting on their motorized vehicles to try to kill me.

asia 2.0

speaking of trips. i am currently in montreal (in a starbucks, i know, just could not get away from corporate culture, or free internet, really)at a conference that i am whole-heartedly ditching. in 3 days i leave for vietnam.
this is the part of asia i've never been to. having survived (and perhaps even mastered?) the deserts of central asia, i am embarking on an adventure in the southeast asian jungle.
this is a medical/educational thing. no more research (at least not active research), no candid sobbing interviews this time. i will be working in a hospital, doing some clinical work, but also educating residents and my colleagues in new and proper ways of contraception...which sounds like a daunting task.
how did vietnam happen? so as part of my fellowship, i am supposed to complete an international rotation. while picking a place, i pretty much was open to going anywhere, except latin america since i speak no spanish, or west africa because i did not want to eat goat stew for the duration of the trip. some very important folks (my super senior boss and some national heads) talked about it, and decided that vietnam would be a perfect destination for me. that remains for me to determine.
i'm excited, but also slightly anxious. the average temperature in vietnam in april is about 98 degrees with crazy humidity (there is actually a tiny little temperature bump up if you look at the overall upgoing curve of temps, damn), which means there will just be more sweating. while getting vaccinated, the travel nurse went over foods to avoid, in order to avoid violent diarrhea. street vendors are off limits, so are fruits and veggies, cooked meat is a go, and carbs are ok. so lots of meat and no fruits and veggies...oh and also, i am not to pet monkeys! so far, this trip does not sound fun at all. sweaty, full of meat, no veggies, and no monkeys. sigh.
i keep freaking out, with bridget jones' diary 2 playing in my head, with me being imprisoned in vietnamese prison, and having to trade my bra or sing madonna, and i'm not sure which one terrifies me more. and while i continue to panic over how many pairs of shoes to bring, i keep having flashes of apocalypse now and wondering if i should take the captain willard approach and trust no one, while mysteriously immersing deeper into the jungle. or if i should emanate tony (bourdain) and follow his steps while marveling at the cuisine...while also chasing kurtz. although tony would not have liked to travel with me. i guess the adventure, like i said before, remains to be determined. i must not pack too many shoes.

coming out

It's been a while. i realize the blog often relates strictly to travel and it should not, or rather...i've been thinking about this for a while. as many of you know i am in a fellowship. a family planning fellowship, which in and of itself is a bit controversial. family planning, for those who dont know, refers to contraception and abortion services. as such, i am a trained contraceptive expert and an abortion provider. and while i love what i do, what i do is controversial.
i take care of women every day. i take care of women who are young and old, pregnant and not, but mostly, or at least in this particular time in my life, i take care of women who are needing to terminate their pregnancy. there is no singular reason for it: some women are really sick, some are facing a pregnancy complicated with terrible abnormalities in the fetus, such abnormalities that would condemn this future child to medical problems, surgeries, and likely stifled and diminished existence. for some women, the time is not right to become a parent. i provide care, a legal procedure, that is safe for them. for this, however, my colleagues and i are frequently ostracized, victimized, threatened.
i wanted to write about my experiences, experiences of my friends, who face protestors and threats of violence for them and their clinical staff. i wanted to write about the need i feel to speak up, and just lie about what i do, not to hide this abortion talk amidst some polite bullshit about how i do research (ok, i also do research, but you get the point). but i think, instead, it is important to focus on my patients. they are women, just like you and me. sometimes they are young, sometimes they are older. many have kids, and many choose to seek abortion services out of love, both for their existing children, and for their unborn fetuses. many struggle financially, scrape just enough money to cover this procedure. for many, by the time they find enough money, figure out how to leave work, and arrange child-care, they are further along in their pregnancy and the money they've got is not enough. many travel from far away. illinois happens to have less strict laws surrounding abortion care, so women travel from out of state--ohio, kentucky, wisconsin--to obtain a procedure that is actually legal federally and in all states. many have to leave their kids, with strangers, just to make it over for their procedure. many are single mothers, many have loving and caring partners and are making this decision with their love and support. many are brought in by their parents or sisters, or older women who have been through the same thing (did you know that one in 4 women has an abortion?)
for many, this is a hard decision. many cry, many are scared. and i hold their hand and tell them it will be ok, because it will be. but regardless, my patients are making a decision that they are sure of, that is right for them, and that is the right guaranteed to them by the constitution. i dont want to get political here. the point of this coming out story is to share, with my friends who may not know, and to speak up on behalf of my patients and my colleagues, against violence and stigma that often surrounds the medical work that i do.