I’m on holiday for my sixtieth birthday in Bali. Holiday from blogging, too. Some photographs on Facebook and google plus. Back in action in June.

Chatuchak Market parental guidance not required

Some photographs I managed to take. They really are not very ken for people to have photographic evidence of what going on.

Bangkok Flower Market

After the massive flea market that is Chatuchak, I decided to have a boat trip. the Chao Praya river runs a looping course through Bangkok. There is a public water bus service , which is very cheap. I struck up a conversation with a Thai couple. Adam worked with an agency charged with improving public awareness and preparedness to disasters. Rachel was a TV reporter and newsreader on Thai television. She said, “Why not come with us to the Flower Market?” How could I refuse?

Chatuchak Market

The biggest outdoor market in Asia is “JJ” market, a few miles north of the city centre. It is the last stop on the Skytrain, at Mo Chit. Sometimes the stalls outside the market are better value, as they don’t have to pay market tax. The food certainly is better and cheaper, less touristy. After a bowl of spicy noodle soup, I walked to one of the entrances and was intrigued to see a sex shop. Well, it wasn’t exactly Anne Summers, but there were a few vibrators, dildoes, and the usual fake Viagra. But what caught my eye was a few small bottles of liquid labelled as promoting hair growth.

Now I’ve worked in the GUM clinic for long enough to know that when it comes to pubes, the modern fashion is the fewer the better. So I asked the stall holder what was this about? He said more hair made a man more sexy. “On his head?” I asked. No. “On his chest?” No, on his upper lip.

Many Thai men have a straggly moustache which Is not impressive to the ladies. What they want is a “Tom Selleck” sort of ‘tache. I asked if I could photograph the stall. “No way, it will all be on the Internet by tonight,” replied the vendor. So I told him that I was a sex doctor, but that didn’t cut any ice. There are lots of sex doctors in Thailand. I offered to buy something, and saw this strange box promising lots of added pleasure. I didn’t know what it was, so I turned it upside down, and a rubber vagina fell out. He was not impressed and that is why there is no photograph accompanying this post. I’m sorry. I tried my best, but it just wasn’t good enough.

Bali Hai

Bali Hai

I flew down from Mae Sot to Bangkok on Friday evening, en route for Bali,where I will be spending my 60th birthday. The plane had to divert to avoid some stormy weather probably caused by cyclone Mahasen, which hit Chittagong in Bangladesh on Thursday. Here is a picture of the clouds we had to skirt around.

Pink Elephants

“There is a mad man we want you to see, doctor,” said the medic in charge of the out patient department. After having done some teaching on recognising mental health problems a few weeks ago, I was delighted to be consulted. While the medic related the brief history, I observed the patient. He was in his early thirties, casually dressed, fidgeting with his hands, pulling at his shirt. He had obviously been escorted to the clinic by his family, as his mother and wife sat on either side of him, trying to prevent him from fleeing. His eyes were wide with terror, and he kept a giving furtive glances over his shoulder as if he thought something menacing was behind him. He was trembling with fear.

The medic said that the patient had had several episodes of being very afraid over the past two years. He said that he could see things that no one else could see. “What kind of things?” I asked. “I didn’t ask him,” replied the medic. I explained how important this was, and eventually we found out that he saw ghosts of people. He looked down at his feet, and started scuffing at the linoleum with his toes. I looked at the medic and drew his attention to the patient’s behaviour. “What’s he doing?” I asked. “I don’t know,” replied the medic. “Can we ask him?” The man said he could see the television on the floor, and it was coming inside his body. “Does he hear any voices?” I asked. “Yes, he can hear our voices,” said the medic. “Any other voices?” “No, he just sees things that aren’t there,” said his mother.

I asked the man to get up onto the examination couch, but he spent a minute scrutinising the surface, brushing away invisible contaminants. When he did settle down, I examined him but could find no signs of any organic illness. The patient clearly did not want to be in the clinic, and despite his mother trying to keep him calm, he walked off into the courtyard.

I found out from his wife that they had been married for two years. “And was he like this when you married him?” I asked. “Yes. He’s always like this when he stops drinking,” she replied. It became clear that this man drinks as much as he can, whether it is local hootch, bottles of beer, Thai whiskey, Burmese rum, basically anything he can get his hands on. He didn’t look well off, so I asked where he got the money from to drink so much. “Oh, his friends buy it for him,” his mother replied. He last had an alcoholic drink two days ago.

He was suffering from delirium tremens, with hallucinations, delusions, agitation and confusion, caused by withdrawing from alcohol. I have dealt with many alcoholics in my medical career, but I cannot recall seeing someone with “DTs” for over 25 years. Medical students learn about heavy boozers allegedly seeing visions of pink elephants when they stop drinking. I have even bought a bottle of very strong beer in Belgium with pink elephants on the label. But I suppose everyone’s hallucinations are different.

We tried to get him to stay, but he refused. We loaded him up with thiamine and other B vitamins, gave him some diazepam to reduce the risk of his having an epileptic seizure, and asked him to come back for review today. He didn’t turn up for his appointment. I’ll probably never see him again. Unless he turns up in the Big Four bar, round the corner from my guesthouse.



Lighter workload at MRC

This morning, I did a ward round at MKT and then drove to another smaller clinic, MRC. Because I go every Wednesday, patients will come on this day to see the doctor, have their condition reviewed or get a second opinion. 

One young lady has been ill for a while with generalised body pain, itchy rash all over her body, bouts of fever and some swelling of the face and legs. She has blood and lots of protein in her urine, but no urinary symptoms. We have a biochemistry analyser at MKT, which allows us to investigate patients on site, without having to send samples off to the Thai public hospital laboratory. I suspect she has renal disease.

The baby with cleft lip also has a small cleft palate. This didn’t interfere with breast feeding and the child is on the waiting list to see a team of visiting specialists at Mae Sot soon. At three months, she could have had the lip repaired but most surgeons wait until the child is 12 to 18 months before undertaking repair of the palate. These babies often get middle ear infections, but this child was fine. I just need to make doubly sure she is on that waiting list.

The little girl has an infected meibomian cyst in the eyelid. At first I thought it was a style as it appeared to be pointing beneath a couple of eye lashes. I tweezered these out, but no pus. I prescribed antibiotics and hot compresses, plus massage, as frequently as she can. I should have realised this was the diagnosis when her mother told me she’d had similar problem in the other eyelid last year.

I was interested in the dark rash on a middle aged woman’s calf. To me it looked like a fungal infection, but I couldn’t work out why it was black in parts. “That’s animal faeces,” said the medic. “She says it works much better than the anti fungal cream we gave her at the clinic.” Well, if cow pat therapy becomes less effective, we might try oral anti fungal treatment instead. I know enough not to argue against traditional medication, especially if conventional therapy has failed. We lost the battle, but might well still win the war.

This mum isn’t worried about her child’s prominent ears; she has exactly the same feature. The child looked such a sweetie, despite having a viral upper respiratory tract infection (that’s a cold, in doctorspeak), I felt I had to take her picture.

The man with the bulge in his right armpit and chest came to clinic but he was casual migrant worker, paid less than £2 per day. He couldn’t afford to wait to see me. He knows we think this is a lymphoma, and he needs to go to Yangon in Myanmar to get treatment from a cancer specialist. We did some blood tests, but these didn’t show any other more treatable cause for the swellings. He has developed similar swellings on both sides of his neck. I still find it difficult knowing that this man will probably not receive treatment which could have cured him, because he is poor.

We brought another infant to MRC from the in patient unit at MKT who is also on a waiting list, for cardiac surgery. Child’s Dream takes on a small number of children with congenital heart disease for corrective surgery. I am worried about this one year old because there isn’t a great deal we can do to help, using medication. The child is failing to thrive and his heart might not be able to cope with the stress of another illness. Another ethical dilemma for me to think on.


Clip Joint


It’s been six weeks since my last haircut so I dropped by at my local barbershop for a trim. I picked this establishment because it looked down-to-earth, with no frills. After investigating the fancy Burmese salons showing illustrations of swooping hairstyles last month, I decided a elderly Thai barber was more my style. I took this photograph while I was waiting, sitting in a sunken leather chair with no arm rests.

The television was blaring out daytime Thai entertainment. Above the set, there was a photograph of David Beckham, sporting a “fin” hairstyle from about ten years ago, when he was being sponsored by Brylcreem. On the floor, there was a grass brush and a beer can. The price list on the wall suggested that whatever cut you got, it cost 60baht (£1.20). I assumed that the 180baht option was for full body depilation, or the Thai version of a Brazilian for chaps. I didn’t want to go there.

The barber’s chair was superb. Red leather, with stainless steel superstructure. It swivelled around and could be tilted to the horizontal, just like in Sweeney Todd, Demon Barber of Fleet Street. There was a bewildering array of instruments on the counter below the mirror. Tools to scrape out earwax, different versions of cut-throat razors, ancient scissors, clippers and shears. Under the counter were several drawers containing powders, creams, spare blades, shaving brushes and talcum powder. Perhaps even something for the weekend.

I was surprised to see a framed newspaper article featuring my chosen barber fixed to the wall on my left. The paper was yellow, faded and fly-blown, but it clearly showed “my man” in action with comb and scissors, probably from a decade ago. Perhaps the Mae Sot Daily News had a regular column on hairdressers, and this was his fifteen column centimetres of fame. But I like to think that, in his day, he had been a star, a real player worthy of note.

When it was my turn, the barber asked me what I wanted. Not knowing the Thai for “short back and sides”, I just motioned to my hair, and he seemed to understand. See how easy it is for us blokes, ladies? I didn’t even bother pointing to Beckham’s portrait and then to my head. He tucked a towel around my neck rather more tightly than was necessary, and shook out a yellow cape over my body, tucking it in firmly. I looked in the mirror and noticed for the first time how thick his glasses were. These glasses were like the spectacles that people used to get after having cataract surgery when they didn’t replace the cloudy lenses with plastic ones. Too late now, I was trapped.

He started off conventionally enough clipping the back and sides, but then he started mixing some shaving soap and applied it above my ears and around my neck. He used an open razor to define the edge of my hairline. He strimmed my
eyebrows and ears, then cranked the chair into a horizontal position. Now I’m taller than most Thais, so my head was hanging over the back of the headrest, even with it extended. He left me in suspense while he brought a scented cold towel to drape over my face. This was it, I thought, the ear-to-ear slash with the razor. But no, he started giving me a massage.

The massage was mainly around my neck and shoulders, but also down to my forearms and hands. He obviously realised how tense my neck muscles were, holding my head up, so he gave them a few gentle karate chops. Then I was cranked back to the vertical, and he used the cool scented towel to give my whole head a gentle rub down. That’s it, I thought, but the next stage was a wet shave. With cold shaving soap. And a dull, cut-throat razor. Rasping.

Now when I shave, I tighten the skin of my face to get a smooth, taught surface to scrape. The barber was stretching the skin of my cheeks to get this effect, but what about my upper lip? I decided to help him by stretching my upper lip over my teeth, my tapir impersonation. Goodness knows what he thought, he just kept on scraping. Finally, it was over. I paid him £1.20, gave his apricot poodle, tethered to the table leg by its leader, a friendly pat and left feeling a new man.

Next time, I’m going to Tesco, for a Vidal Sassoon Experience, at four times the price, that I’d enjoyed in January.