A Day with Siam Care: Part 2

"Time to introduce the second family," said Em from the backseat of the Siam Care pickup. I listened intently as she told me their tragic back story. The mother and six year-old daughter are both HIV+, the father was killed in the tsunami, and the grandfather is paralyzed. None of these hardships were evident on their smiling faces, however, as we pulled up to the open-air community center where they were living in a house supplied by the local government.

The mother grabbed us a straw mat and laid it down on the concrete floor, while also bringing over a fan to keep us cool. She then set about conversing with Siam Care about their lives and needs. It was a very casual, friendly environment, and other friends from the close-knit community gathered around as well. The daughter plopped down on Em's lap. She looked perfectly healthy, smiling and energetic as she played with another young girl. Perhaps a little undersized for her age, she'd not yet suffered any ill effects from the virus. Yet, as I told Kendra later, it's still tragically sad seeing such a young girl affected by such a terrible illness.

The mother was kind enough to grab her medications for me to analyze, and had a friendly reply to all of my questions. Her treatment appeared to be a little more comprehensive than the man from earlier, as she had a protease inhibitor, a reverse-transcriptase inhibitor, and a drug that inhibits viral genome production in addition to other supplemental drugs, rather than the simple 'all-in-one' anti-viral pill from earlier. That's part of the problem, Nay would tell me. The information is out there and guidelines exist, but without consistency in how they're enforced or implemented. This too often leaves it up to the idiosyncrasies of the physician in charge of that individuals care, and in this case, the difference between a thoughtful, proactive doctor and an ill-informed, disinterested one could mean years of life for the HIV+ patient. It's a powerful testament to the importance of educating not only the general populace, but the health-care providers who also face this disease.

As I finished looking over the medication, I asked of any ill-effects from taking them. The drug cocktail itself can have some powerful side-effects that compound upon the difficulties of living with HIV. In this case, the mother was suffering from what's called 'lipodystrophy,' where the body's fat deposits are drastically changed in shape. In this case, she had the classic signs of the body fat having drained from her appendages and cheeks and deposited in her abdomen, resulting in an enlarged midsection. It's quite sad to see the physical effects of the illness, especially to someone so kind and welcoming to a complete stranger.

Kindness and hospitality would be a very consistent theme among the families we would visit, as we headed to the last household. Arriving at the woman's house, I was soon told, "You're the first foreigner that's visited her home. She's excited and is going to make us a meal." I was quite honored to receive such a welcome. Papaya salad was prepared in a mortar and pestle, consisting of a unique tree fruit, having a water-chestnut like consistency, mashed together with sugar, garlic, and chilis. Just one chili, I was assured, as my American heritage makes me no match for the level of spice preferred by the Thais.

The woman also went out and bought some sticky rice, pork strips, and sauces to augment the papaya salad, and we all shared the small feast. Though I forewent partaking of the pork, vegetables dipped in the spicy sauce that accompanied it was delicious. Afterwards, Nay and I went back into the house to sit on the floor and discuss the woman's treatment.

When she first learned of her status, she told me as Nay very kindly translated, she thought about hanging herself. But it was her husband that convinced her to fight, for the sake of her life and for their young children. She's currently working as a fisherman, no small task for a woman of her tiny stature. The ocean, especially at this time of the year, can be extremely rough, and just a month ago a friend of theirs had his boat sunk by a collision with another vessel, forcing him to swim to shore. She can't swim, she informed me, but the work is vital to pay for the rent in their small home and for their children's education. To think of how brave she must be to fight such a terrible disease while having to work in such a physically rigorous environment was inspiring.

As we kept talking, she noticed a bead or two of sweat on my forehead and immediately jumped up to adjust the fan slightly further in my direction. It was incredible that someone in such a difficult situation can be so hospitable and considerate. I told her that I would do my best to visit her again when I return to Thailand after medical school, and she promised me that I would always be welcome in her home.

Such an outpouring of kindness was only exceeded by the incredible deluge of rain that greeted us upon returning to Khao Lak. It was an inspiring day to say the least, and I'm extremely grateful to Nay, Ying, and Em for letting me accompany them on the home visits. Please feel free to again check out their website, and I would certainly challenge you to consider supporting their very noble efforts here in Thailand.