Sylvia's Journal

I usually join our wheelchair training team when the practical clinical and technical work is done. Together we then teach the managers or supervisors of the participants in the just completed training how to run the wheelchair service in a way that supports the new skill set of their staff so they can start practicing right away. We cover everything from demand generation, organization and patient flow, finances, fundraising, monitoring and evaluation, managing change and staffing, while also helping them to understand the big picture of wheelchair service delivery.

We don’t always get the right people in the room. I had been forewarned about how hard it was to engage people and get them to speak out. Sometimes it seems that the only inducement to come to this kind of training is the per diem – the daily allowances that serve as a nice complement to, probably very low salaries.  It makes little sense for people who are already at their usual workplace but they demand it anyways. We follow strict US government guidelines, but people try to wrangle more out of us. This is what my colleague M has to deal with, over and over.

It is the per diem curse that haunts many of us and that has contaminated what we would consider a drive to learn. Like in other places, I assume this drive is there, with curiosity as its signpost. But there are only a few that show this.

It is complicated to teach the management course: there is a script that I find hard to stick to as it is a PowerPoint lecture-based set up. Especially on the first day there were many blank stares and people getting hopelessly tangled up in very basic math. Add to this that the slides we project are in Lao script and the tangle of wires and ear buds and mics for the simultaneous translation, teaching these classes can be quite unnerving in the beginning, even when one knows the topic very well.

And then there is the culture: a communist party culture superimposed on a highly stratified society and the trauma of the Vietnam War. Altogether it makes for a challenging teaching experience. It takes me about two days to get the hang of it and establish the kind of relationships that allow us all to relax and enjoy the opportunity of working towards something all of us deeply care about.

Then, after the management training was done we had a stakeholder meeting, bringing together key movers and shakers who are invested in pushing the wheelchair agenda forward, as part of a broader commitment to implement the UN Convention of the rights of people with disabilities.

Usually we have two days for this event but this time we were given only one day. For this meeting there is a script too but I never follow it as these kinds of meeting are too contextual to allow for a cookie cutter approach. I do have developed a kind of formula and then riff on that: where are we now? Where do we want to go? How did we get from here to there? Who is leading and coordinating efforts after today?

The complications of how to do small group exercises when the set-up is for simultaneous translation is something I had not fully grasped during the design phase. We managed anyways, reminding me that ‘where there is a will, there is a way.’

Other than our short daily drive to work, I didn’t get to see much of the city. In the tourist brochures I saw pictures of all the beautiful things I could or should have seen – I suppose it requires going here as a tourist. I also learned, a little late, that I had pronounced the name of the capital all wrong. It sounds more Chinese than French (wiet chan).

The one tourist stop I did see was the COPE museum of the Vietnam War’s sad legacy of unexploded ordinance (UXO) and mines. The museum receives a constant stream of tourists which we saw passing by our training room, located in a large complex dedicated to people with disabilities. The rehabilitation center also receives a constant stream of requests for artificial limbs and wheelchairs for people who were mostly (or currently are) innocent bystanders of this devastating war.

One of our participants is from the northern part of the country, from the Hmong tribe which is present in a wide band below China. Thousands of Hmong were recruited by the CIA to fight the communists in Indochina during its ‘Secret War.’ As a result they were persecuted and many fled to Thailand and other places further away, like Minnesota. Anne Fadiman wrote a beautiful book (and intensely sad) about the latter group and the resulting culture clashes between two medical world views.

The young gentleman told me that his father recounted to him the horror stories, experienced while he (the father) was still a child. That generation was severely traumatized by memories of bombs falling, killing squads in the jungle and the dangerous Mekong crossing. His grandfather didn’t survive. He does have relatives in Minnesota and his uncle wrote a book about crossing the river. When I googled this I came across more nightmare memories. The Vietnam War is still very much alive here.

The part of Vientiane where we are lodged is awash with small restaurants and massage places. At the end of the road, snaking along the Mekong River, is the daily night market (6-10PM). It is a poor cousin of Bangkok’s weekend market, full of cheap Chinese wares and some local handicraft.

During one of our evening strolls looking for a restaurant we found a boutique hotel (Ansara) that we should have stayed in. Its lovely French restaurant offered set menus and good wine for a reasonable price. Across the hotel we discovered (with some help from Trip Advisor) a very professionally run spa. We started to visit it daily. Upon entering one receives a thick menu book with choices. I tried the one hour leg and foot massage which ended with a neck and shoulder massage, thrown in as a bonus. I would have liked to propose to the diminutive masseuse to come home with me.  I had my body scrubbed for an hour with the promise of a sense of (cell) rejuvenation – one of the few options available after dinner. The chief masseuse was very strict about ‘no whole body massages (nor sauna) directly after dinner.’

And for our last day I chose the sports massage which was delivered with more force than seemed possible given the size of the masseuse. Now, more than24 hours later my muscles are still wondering what happened to them. That was it for massages in the short time I was there.

As we landed in Laos, I couldn’t help but think what would have happened had I not divorced P in 1979. Just before he died last year he became consul for Laos in the Netherlands; he had lived some years here.  How different things would have been: no Sita, no Tessa, no Faro, no Saffi. I would not have gone here on a business trip, but I would have known this place.  I wouldn’t have minded living here for a bit, but there are no regrets.

I was whisked away from the tiny airport in an elegant van to our boutique hotel. I look out over a temple complex with fantastical roofs.

I joined my colleagues who have already spent 2 weeks here, training staff of rehab centers how to properly prescribe and fit wheelchairs: a physical therapist from the Philippines, a colleague from our Arlington office who looks after the very complicated logistics and an occupational therapist from Israel. The latter is now on her way home, her job done. The three of us will stay. We have done this training and aligning of wheelchair stakeholders together before: twice in the Philippines, in Mongolia and in Cambodia.

It was a nice reunion which we celebrated at a French café. We had quiches and ‘pain de mie’ with Norwegian salmon.  Vientiane is very French; we are in the old French ‘Indochine,’ after all. Government buildings have their Latin script names in French.

Our departing team member got to choose the venue for our farewell dinner. She picked a restaurant already tested and approved, especially for its frozen chili margaritas. It is a social enterprise restaurant, where unlucky kids turned lucky served us a most wonderful meal.