INFECTIOUS TALES

(Probably not so appealing to the squeamish – but good lessons to be learned…)

Some Pointers from a non-medical perspective:

• Keep any open wound clean and covered when outdoors. Use your bottled water, and keep a supply of dressings.
• Draw a circle (with pen) around any red areas. This is a sign of infection – if it is getting bigger, you have a problem.
• Get any escalating problem seen to! Check the cleanliness of any medical help you get!
• Don’t leave it, it is not like something back at home that fixes itself.

After too many tales of wheelchair bound travellers returning to Australia for treatment of infected wounds in the tropics (hey Kyra, hey Nik) I never wanted to get to that stage.  So when I fell over a drain (no I wasn’t drunk… see future post for the state of the footpaths in this region…) and grazed my leg, I made sure to clean it thoroughly and report it to my ICM (in country manager – for ‘just in case’ insurance purposes).

The graze seemed ok and I covered and kept it clean, although was a raised lump underneath that wouldn’t go away.  After a few weeks I thought I’d better get it seen to.  I happened to walk past a clean looking medical clinic whilst away in Pakse (we’ve been warned not to get treatment for anything serious locally – I’ve visited the local hospital and can vouch for this!)  I went inside and surprisingly the guy at the desk had some English and took me in to see the doctor.  Again, minimal English but he ordered a blood test to check for infection, and sent me off with the nurse (who had no English at all).

She was good, laid me down on the bed and began work.  She cleaned it.  Then she dug a hole in it.  (youch).  She put what looked like a metal scone tray under my leg. Then she squeezed it.  (oooouuuucccchhhh).  Hard.  And harder.  I could feel something running down my leg and sat up to see … (bluuurrrrrgggghhhhh).  Well it was mostly blood.  Coagulated blood.  And clear fluid.  She made me lay back down AND KEPT ON SQUEEZING as hard as she could.  By that time I was biting into my finger and making little yelping sounds.

The big lump under my skin was not quite so big by the time she stopped squeezing, but she hadn’t finished yet…  She kept on saying, encouragingly, what I thought was ‘saep lai’ – which in my limited Lao means ‘It’s very delicious’!  Couldn’t be, surely?  (Later I checked my dictionary, the word for ‘infected/inflamed’ is ak-sayp – I’m guessing this might have been what she was referring to…)  By that time I was saying no, no, that’s enough!  I then watched her as she took off her sterile glove and began cutting a strip off it.  I think I must have been distracted by more pain as she worked away and was utterly relieved when she covered it up and let me go.  The doctor wanted to know how to spell ‘divorced’ and was very happy at learning a new word in the form filling exercise, and sent me off with a warning that it needed to be checked again the next day for more cleaning and signs of spreading of infection.

Back at the hotel the next day, after letting my ICM know, and him putting all resources into immediate action, I was waiting to be picked up by a car that would take me back to Savannakhet to pick up my things before getting to a place with more medical help.  My friend and colleague (working in Pakse TTC) was with me and I thought I’d better check the wound and wash it down, and re-cover it (the nurse’s handiwork with a bandage had actually fallen off as I was walking and it was looking like a right old mess).  So I poured some bottled water over it and wiped around it to make sure it was clean.  I noticed a little bit of white stuff on the sore part, maybe a bit of stray bandage, so I pulled on it.  Poor Debbie was my witness as I pulled out about 10cm strip of plastic sterile glove OUT OF MY WOUND.  (gulp, eeerrrrgggghhhhh)

OK, get over it, driver was getting impatient so cleaned and covered it again and got into the car.  The driver also had no English – he was not the regular driver, and I realised later when we were driving around lost in Savannakhet that he had no idea where to go.  The trip that took the bus 5 hours was done in about 2 ½ hours.  We passed every vehicle (and animal) on the road.  He drove like a mad man.  He refused to stop for anything, even though I was hanging out for a smoko.  When it started getting dark (about 5.30pm) I could see why he was in such a hurry to get on the way.  All those obstacles on and beside the road – bikes with no rear lights (often they ride with no front light on either, and on either side of the road), slow vehicles, cows, goats, dogs … bad enough in the daytime – far worse at night and in a hurry!

Well, made it home ok – forgot to mention the other complication, my phone had broken, being Sunday the shops were closed, my (work) computer is a dud and won’t let me get online, so I was also relying on other people with phones…  Thanks to Debbie in Pakse, and Susan in Savannakhet, and David (ICM) for his initiative, all things were put into motion.  Finally home I packed my bag (medications, passport, clothes for a few days) and managed to make contact with the medical insurance company and send them the latest photo of my wound.  I seemed to remember in the case of an infected abscess a few years ago (another joy of diabetes) that it was useful to draw with pen around any swelling or redness so hence the artwork around the wound in the photos.  Luckily it didn’t seem to be spreading or swelling up further.

The next day the medical insurance people were still umming and ahhing about whether or not they’d cover me for a trip to a decent medical facility.  They decided yes at about 3pm and I headed straight off to airport for the ‘4pm flight’.  By that time the last plane was fully booked and I was put on standby – first they just said no, then after talking with David on my new phone (I’d been busy that morning – new phone but almost completely broke) said they would know by 6pm if there were any ‘no-shows’, and hence a seat available.

The Airport Viewing Lounge

The beer Lao – locked away.

At 6pm, after hovering around the sales office for 20mins, they asked me in, took my passport, looked at the computer and I got the ‘computer says noooooooo’.  Sorry?  No!  Look, I need to get to the hospital (big sad face).  Some more tap tap tapping on the computer and it seemed that one seat had appeared out of nowhere, and it had my name on it!  Phew.  Flew out on the 4pm plane at 6.30pm, surrounded by empty seats.  Huh?  But then we flew south to Pakse and got off the plane to pick up the rest of the passengers and sure enough, it was full to brimming!  Onwards bound, north to Vientiane, and taxi to good old familiar Alie and Hotel Lao.  And my Korean friends at the nearby restaurant who still remembered me from 6 weeks ago and invited me to join them.

Set off to Australian Embassy Clinic the next day.  Dr Michelle is a breath of Australian speaking fresh air.  I love her!  And she speaks the Aussie Lingo!  Even if she does make babies cry (the previous patient was there for her jabs).  She congratulated me for coming in and having it seen to, and commented that the Pakse Clinic had actually done all the right things – blood test, cleaning out the wound and keeping the wound open – hence the rubber glove trick.  Put me on antibiotics (Augmentin Duo), took a swab to check what the infection was – ie what antibiotics would work – cleaned and covered it, and asked me to come back so she could check it the next day, and then for reassessment on Friday.

It is now Wednesday, and she is pleased with progress.  Still oozing, still red and inflamed, but getting better!  So fingers crossed that the wheelchair will not be needed in my case!

After a number of checkups and some good times in Vientiane (luckily I only had a sore leg, no other symptoms) I was declared fit and ready to travel on Tuesday.  Unfortunately no flights to Savannakhet until Saturday so this little trip for good medical intervention turned into quite a long stay away from my home and workplace.  I have learnt some more lessons along the way and had rather an eventful two weeks.  Left work on Wednesday October …. Headed for Pakse  (see Pakse and Beyond post) and returned to work itching to get going on November …….  Wouldn’t want to be in a hurry!  (Luckily I’m not…)  Bor Pen Nyung (it’s ok…)

A Short History of Laos: The land in between by Grant Evans

A very informative detailed and authoritative history (2002) of the complex background to modern day Laos – now the Lao People’s Democratic Republic – the ‘s’ is absent in the Lao language.  (Laos is the noun, Lao is an adjective).

Evans begins his book “Before Laos” – when much of South East Asia consisted of formations of traditional kingdoms who fought and often absorbed one another.  The ‘mandala’ systems …

model an idea of the cosmos that includes the human body and the state.  In relation to the state, the mandala represented a geopolitical idea used to discuss the the partial configuration and fluctuation of friendly and enemy state, from the point of view of a particular kingdom … The mandala states were focused on sacred centres ruled by a king who had direct access to divine power and used that power to create worldly order” (p6).  

Laos as we know it later emerged at the end of the nineteenth century as a national entity, but prior history is certainly the precursor to contemporary ethnic diversity, and complexities of identity and belonging.

Mountains are destroyed, they have collapsed and are strewn about

The edge of the land is pulverized,

There is great turmoil in the villages, which are dark with smoke; the eart is on fire

A shadow covers the brilliance (of the moon) which disappears in the clouds

The universe is overturned and broken; the land is unbalanced; it quakes and trembles.

(cited from an annotated translation of Leup Pha Sun by Peter Koret, Evans 2002:51)

Evans organises his chapters as follows:

1. Before Laos
2. Le Laos Francais
3. The Royal Lao Government
4. War, and the destruction of the RLG
5. The Lao People’s Democratic Republic
6. Laos in the Modern World

A ‘colonial backwater’ of the French empire of Indochina during the 19th and early 20th century, “by 1954 French colonialism in Indochina had collapsed” (p.39).  Evans discusses colonialism and racism, “White settler societies, founded as they were on the denial of basic political rights to the indigenous population whose land they had usurped…” (p.59).  He also emphasises the lack of ‘Lao Nationalism’ as “even for the French, Laos was, at that time, more a cartographic reality than a social or historical one” (pg71),

World War two, Japanese activities in the region, Thai and Vietnamese neighbours’ own problems, various monarchies, elites, activist groups, created all number of tensions during the 20th century, leading up to the Vietnam war in which Laos gained the notoriety of having more bombs dropped    The Cold War, dependence on American aid, internal corruption and growth of military power, the 1960s growth of a “thoughtful and critical intelligentsia”  that would soon disappear with the communist victory of the 1970s are discussed in detail.

Some subtitles:  A new sensibility; Social change and cultural anxiety; Facing the dilemmas of development; Corruption and familism; Opium politics; The royal family; and the Final coalition give some indication of the key issues of the mid to late 20th century in Laos.

The harsh regime that came to power in late 1975 caused many Laos to flee their  country.  Hmong fought on for several years … the LPDR put in place all the usual trappings of a tightly controlled communist society … in the 1980s market style reforms began.  The 1990s saw considerable relaxation of state control of everyday life … The sate, however, kept tight control over the mass media and political activity, although by the late 1990s there were some signs that this control was slipping. (p.176)

Moving into Laos in the modern day (final chapter), Evans highlights the huge population growth in recent times, and the various ‘knowledges of the past’ that each of the new generations have.  He discusses the various ‘silences’ about the RLG (Royal Lao Government) period ‘almost as if it never existed’ (p.255) and stories that were told were ‘episodic and fragmented’.

Many young Lao are uncomfortably aware that they once had a king, but know little about him or about his demise.  School textbooks in many countries are notorious for their biased, nationalist representation of history, but the need in Laos to place the Communist Party at the centre of its history produces a further distortion. …  these multiple distortions of history produce strange ellipses and silences in the various narratives and discourses found within Laos today. (p.255)

This is admittedly an extreme summary of Evans’ contribution to an overview of Lao history.  The book details many of the political uprisings and complexities over a long history leading to the present day (ok, up to 2002).  I wanted to get a better idea of how this country has formed and asserted its own identity and note its quite different emphasis to that given by Vatthana Pholsena in her book Post war Laos-the Politics of Culture History .and Identity.  Clearly there are other perspectives on this history and I look forward to hearing (or not) those perspectives held by those I will be working and getting to know from within Laos itself.

All history, even recent history, is subject to interpretation.  Different historians offer varying perspectives on the past, sometimes due to different political persuasion or theoretical approaches.  The rule for historians in liberal democracies is that everything we know about the past is potentially open for discussion, and no facts should be suppressed.  Historians may differ about the relevant facts, or the weight given to them, but they agree on their open and free discussion.  (Evans, 2002: 256)

Language & Culture: Laos (& workplace communication)

Language & Culture: Laos  Background notes for teachers in the Adult Migrant Education Program by Jean Brick (1984)  

Book produced by the NSW Adult Migrant Education Service (borrowed from Deakin University Library)

Interesting reading!  Clearly some changes may have happened in the 30+ intervening years but I imagine that knowing the older or more traditional forms of address and a bit of history remains useful.

Some items of particular interest to me in regards to cultural expectations and relationships – I am somewhat nervous about establishing relationships with my work colleagues as I have a fundamentally (privileged) Western ideal and expectation that hierarchies and level of respect ought to depend on actions rather than given titles, which can of course take some time.

An interesting aspect relates to obligation and use of please/thank you, that helps to make sense of why my automated sense of ‘manners’ – ie everyone deserves to be thanked or spoken to politely – is not directly translatable in other cultural/ethnic contexts.

When speaking to shopkeepers or market sellers it was usual to say ‘Get X’, omitting pronouns and using command forms.  Respect was not necessary as payment was involved (p28)

The concept of obligation plays an important part in determining the level of politeness used in speaking.  Children are bound to their parents, students to their teachers and employees to their employers by a network of reciprocal obligations which are continuously renewed and reinforced.  Words such as ‘please’ and ‘thank you’ are seldom used in such relationships as services rendered or accepted are part of the network of obligation.  This obligation must be discharged by service or payment of respect and support.  Thanking in this context would appear insincere.  Nor is thanking appropriate in situations where service is part of a job, for example, in a shop.

Lao students may find the Australian system of politeness which is largely determined by the degree of difficulty or disruption involved, difficult to master.  They may unwittingly give offence by omitting polite forms or ‘please’ or ‘thank you’ when speaking to younger people, subordinates, Australian friends or people whose job it is to serve because in Laos such forms would sound insincere.  

Conversely, when speaking to older people or people of higher status, (eg teachers, employers, managers, etc) they may sound obsequious or over-polite because they attempt to translate Lao respect into English politeness.  (p40)

I found this section particularly interesting because I’d just read an interesting article Cultural orientation to Australian workplaces by Dr Lynda Achren (fine print vol 36#2 2013) in which she discusses the ‘hidden hierarchy‘ in Australia’s apparent egalitarian workplaces, and how CALD learners [culturally and linguistically diverse] find this aspect of Australian culture very difficult to understand unless taught/explained quite explicitly.

The problems for CALD learners in Australia seem very relevant to the problems I envisage in working within a more overtly hierarchical society where lines of command are far more clearly delineated and performed.  “where superiors are treated with deference and addressed verbally in terms that demonstrate respect and mark their place in the hierarchy” (p13) which does not sound like my ‘natural’ way of doing things(!)  Problematic issues may result in discomfort, cultural confusion, loss of face, misunderstandings, unclear roles and responsibilities, knowing how to ask questions or give instructions, appropriate levels of in/directness…

Gaining greater awareness of our own culture and how our language reflects our culture, helps us to recognise that there are other, equally valid cultural perspectives, equally valid ways of thinking and doing.   Being equipped with tools for noticing cultural difference, for being aware that ‘something cultural is going on’ helps provide all language learners and trainees with the intercultural communication skills required for a multicultural society and its multicultural workplaces. (Achren,2013, p16)

The section of the Language and Culture book on Laos entitled Politeness, respect and obligations is of course of particular interest to me.  Not that I’m reading it to learn the ‘rules’ of this society (the book is, after all, 30 years old) but in effect, the author Jean Brick articulates more general ‘cultural’ differences I’ve always been aware of through teaching and intercultural communications, but never quite been able to articulate, and all too often, to understand the whys behind the differences.

As this book was published in the 1980s, it is interesting to recognise that a lot of my TESOL training around this time, and after, has taken a different turn, towards non-essentialising discourses, avoiding cultural generalisations and stereotypes, and the integration of differences within and across, rather than just ‘between’.  One of the consequences of this (I think) was that everything became that little more vague, and less specific.  Many of my students have struggled with what they call my ‘refusal to answer questions directly’ or too much ‘abstract thinking’/unclear instructions (oh how I love student evaluations).  So when Achren (above) mentions ‘explicit instruction’, and this book lists quite explicit functional expressions, I am a little hesitant (but surely all Lao don’t do it this way?  And surely I don’t have to do it that way because someone 30 years ago wrote it in a training manual?) but at the same time, who wouldn’t want some insight into how the following functions may be performed in different and/or more appropriate ways in different contexts?

Part B:  FUNCTIONS

The following sub-titles here include:

• Harmony,
• Loss of Face,
• Feelings …

INFORMATIVE

• Confirming
• Predicting
• Correcting
• Describing

INSTRUMENTAL

• Advising,
• Complaining,
• Requesting,
• Giving instructions,
• Ordering,
• Promising,
• Seeking Permission,
• Suggesting,
• Warning,
• Refusing

AFFECTIVE (Expressing)

• ambition
• surprise
• anxiety
• pleasure
• anger
• wants, wishes and needs
• likes and dislikes
• preferences
• satisfaction and dissatisfaction
• sympathy
• good wishes

INTELLECTUAL

• ability/inability
• opinions, agreement and disagreement

INTEGRATIVE

• introducing
• asking for repetition and clarification
• attracting attention and interrupting
• greetings, leave-taking
• apologising
• complimenting
• congratulating
• inviting
• offering, accepting and refusing
• thanking
• exchanging small talk

Some interesting excerpts (to me! – my highlights):

the establishment and maintenance of social harmony is very highly valued … and all things that potentially threaten such harmony are discouraged.  In their dealing with each other people are expected to be respectful, considerate and cheerful.  the overt display of emotions, especially anger or irritation is frowned on.  Given direct opinions or openly disagreeing are also discouraged as they can lead to disharmony (pg41)

The concept of ‘dignity‘ or ‘face‘ is extremely important … avoided by conducting arguments or disagreements at length by giving reasons and by avoiding direct statements of opinion … stress is put on appearing cheerful at all times, regardless of mental state.  Smiling is, therefore, an appropriate reaction covering a wide range of emotions from happiness to anger, embarrassment and sadness … strong displays of emotion, especially negative emotions such as anger or irritation are taken as lack of discipline and can cause loss of face … (pp.41-2)

Laotians tend to avoid correcting others in all but extreme cases …when correction is necessary it will be given in a softened form, roughly translated as ‘I think this is better’.  Alternatively, it can be appropriate to offer to do something for a superior rather than point out his mistake (p 44)

Making complaints is rare… The high status of teachers means that complaints about schooling are avoided.  In Australia, students are likely to drop out of class rather than complain … In general, complaints are avoided because they create disharmony and because it is usually felt that nothing can be done to alter the state of affairs and complaining is a waste of time (pp47-8)

It is rare to make a direct request … A request from an older person or a superior sounds very brusque if translated into English.  Requests from subordinates or younger people are frequently implicit rather than explicit …If the request is made explicit, the reasons for making the request are always given first… (pp48-9)

Commitments to do something are often not seen as binding and time limits are very seldom put on expressions of willingness to do something.  If a person says that he will do something is usually means that if he can, he will and if he cannot, he will not.  If a person, having said that he will do something, subsequently fails to do it, then he might say:  ‘I’m sorry, I forgot’ and this would be accepted as an adequate reason for failure to do the promised action.”  (pp50-1)

While it is possible to refuse a request, the way that this is done varies according to the strength of the ties of friendship or obligation that exist between the two people…  might suggest a later date on which the person making the request could talk to him [which is] understood as a refusal.  … For small things, such as being asked to a party, it is usual to refuse by citing a prior engagement.  (pp53-4)

Expressing anxiety … There is no distinction between fear and nervousness.  Expressions of pleasure are muted and are primarily conveyed through intonation … it is not usual to open gifts in front of the give or to express pleasure … A gift produces an obligation which will be repaid at a future date … Pleasure [in relation to food] is shown by eating the food … (p.55-6)

Rather than stating boldly that something is liked or disliked, it is usual to approach the subject indirectly.  The reason for linking or disliking something is stated rather than the fact of like or dislike … others will remain silent rather than disagree … People seldom talk about their personal likes and dislikes because it is felt that such things are of no interest to others (p.57)

People usually tend to downgrade their abilities and achievements as to do otherwise would be interpreted as boasting or immodest behaviour and as such would be severely criticised … It is rare to state opinions or to agree or disagree directly.  Instead, reasons are given for or against a particular opinion and the listener is left to draw his own conclusions … On all occasions, being forced to admit fault involves loss of face.  People avoid putting themselves or others in a situation that involves admitting being wrong … The appropriate response to the query ‘do you understand?’ is to smile and say nothing. (pp59-63)

In general, Laos do not apologise as much as Australians, especially for minor offences.  For major offences, restitution is expected… Relative age and status is more important in determining the depth of the apology than the degree of the offence… It is very rare to pay anyone a compliment [or to congratulate] … People never comment on how beautiful a baby is.  Instead it is usual to say that the baby is ugly as this discourages the spirits from taking the baby[!]  (p.66-8)

It is not normal to offer either food or drink to a visitor; rather it is assumed that a visitor will drink and it is automatically provided.  The guest would be asked, ‘have you eaten?’  It is usual to give a negative answer, and it is expected that the guest would then either join the family in eating or if the family had already eaten, to eat by himself…   (p.69)

And finally …

Exchanging small-talk

In general, people tend not to talk about themselves, their own activities or problems.  It is also unusual to ask people about their interests or to talk about personal interests as the assumption tends to be that personal interests are of no interest to others.  People do, however, talk about other people’s activities, often in a critical way.  This acts as an important regulator of social activity as people are often reluctant to do things that might result in others criticising them.  …  questions on age, marital status … number of children and whether or not contraception is used[!] …

People also talk about jobs but mainly in relation to wages and promotion prospects … common to ask about the cost of an item … An account of the cost of various things bought for children can function as a way to showing degree of affection for the children 

Educated men might talk about politics but few women would do so.  Sport is a popular topic among men but not women who tend to talk about traditional women’s concerns – fashion, cooking, handicrafts and the family.  … It is not polite to express lack of interest in a topic of conversation nor to attempt to change the subject.  Both can be accomplished by falling silent and not commenting on what the speaker is saying.  (pp71-2)

Wow, it will be really interesting to reflect back on this further down the track.  I suppose I’ve highlighted (without commenting ‘directly’ as such – see, I’m learning) particular points that I envisage having some personal difficulties with.  As I stated above, my own fundamentally (privileged) Western ideals and expectations, combined with a feminist and (I hope) socially just perspective, may well have to take on some new forms of agency and performance over the ensuing 12 months!

References:

Language & Culture: Laos  Background notes for teachers in the Adult Migrant Education Program by Jean Brick (1984)  Book produced by the NSW Adult Migrant Education Service (borrowed from Deakin University Library)

Cultural orientation to Australian workplaces by Dr Lynda Achren (Fine Print vol 36#2 2013)

Expatriates – blogs, advice, adventures, (tbc…)

A blog that caught my attention early on, Mundane Chaos -Misadventures in Southeast Asia came up with a search on my destination (Savannakhet Teacher Training College).  Stephanie Crabtree wrote about her experiences there in 2012/13 with lots of amusing anecdotes, observations and experiences that I really enjoy reading (and writing!).  These are the sorts of stories I like to share/hear about and can give all sorts of insights about expat life.

I responded to Stephanie’s blog and she kindly emailed back, saying she’d almost forgotten about the blog (don’t you love that they just ‘hang there’ forever?) since returning home 3 years ago.  But she sent me some contact names and some helpful advice which is great!

 The Culture blend thoughts on  expatting, repatting, transition and life is another blog I’ve enjoyed, from an ‘expert’ expat named Jerry Jones who writes with a thoughtful, humorous  and wise approach.

The ‘expat’ comes in all shapes and sizes (and income levels).  I like Jerry’s ‘crawl in the hole’ advice (link below) because it pretty much rings true to my own (earlier) experiences.  I don’t think you can ever become an ‘expert’ inter/cross cultural participant because everyone is looking for different things, and that not everybody gets a ‘thrill’ out of being out of their comfort zone.  But … as an older and hopefully wiser participant, I hope that I can retain not only my sense of humour, but the ongoing interest in, and passion for difference.

http://www.thecultureblend.com/

Love to hear about more examples – I will add them as I discover them myself!

Another site with great links and photos about the wonders of Laos!

http://www.mappingmegan.com/why-you-should-travel-to-laos/

#T1D – medical supplies for a year?

(I’m now up to update number 5 on this post … and off to see my member of parliament – this is despicable!)  

Final Update!  see final post… and come visit me in hospital if that’s what it comes to…

Over the 365 days I will be out of Australia, I require:

• Blood glucose testing strips x 1,850= 37 containers
• Tubing and insertion devices for pump x 124 = 13 boxes (x2)
• Insulin @ ~40 units/day = 14600/yr = 146 1ml bottles = ~30 boxes
• Additional ‘spare’ supplies (pens & needles) for any malfunctions

and then of course there is all the other medication I have to take daily (currently 5 different tablets)  x 365.  Aside from the fact that all of this is pretty damned expensive, it is very difficult to get ‘permission’ to get subsidised medication and supplies to take out of the country in such large quantities.  (Strangely enough, I have never had problems with customs in any country I’ve been to – often my hand luggage is actually a cool pack full of medication!)
NDSS – After have no success or helpful information from any source, I sent the following message to NDSS (all diabetes ‘comsumables’ are subsidised and need to be ordered through them) :

I am  volunteering overseas for 12 months in Laos and require 12 months worth of supplies (pump and blood testing strips) to take with me. However, both the pharmacy and the phone line have informed me that I cannot take more than 6 months worth. This is a huge problem for me. I thought that I could get a letter from my doctor to enable me to get extra supplies but nobody can tell me if this is correct. My sister (also a diabetic) is visiting in 6 months time, but apparently she cannot request supplies for me, or on my behalf. Financially, this is also very difficult to pay the subsidised cost in full, but clearly necessary to maintain my health.
Could you please tell me what my options might be?
Thank you, Annabelle Leve

Looking more closely at their website  I see that :

The NDSS gives you access to a large range of subsidised products that help you to affordably self-manage your diabetes. …

There are limits to the nuliving withmber of products you may purchase on the NDSS. These limits are:

• 900 strips …
• 90 cannulae and/or
• 90 reservoirs/cartridges

per 180 day period. …

Access to the NDSS is only available while you’re living in Australia.

If you’re travelling or living overseas, the NDSS is not permitted to send products to you. Before travelling, please review your product requirements. You can buy up to 6 months’ worth of products to take with you, but is also advisable to have a letter from your doctor to ensure you get through customs.

There is also an additional page with some useful information for travelling – but not for 12 month trips obviously!

OK … I’ll be patient – no response yet, to either phone call or emailed message.  I’m still WAITING!!!  I’m getting CONCERNED!!!  I need to get this SORTED!!!

As for the prescribed medication, I’ve been told different things (again) by pharmacist and doctor about “Regulation 24″ which apparently entitles me to 6 months worth – pharmacist advises me to get doctor to write TWO regulation 24 scripts – doctor unaware of such a thing … still on hold for next appointment.  

Oh, did find out that the 2 prescriptions should NOT be dated the same day – the next day is fine, just not the same day (der??) – advice from Pharmacist, but she wasn’t sure either…

UPDATE (12 days later)

Aside from having my arms jabbed at least 12 times over the previous month, and collecting a bag of 12months of malaria prophylaxis, I am in fact none the wiser about how to get my 12 months worth of everything else.  I’ve asked more people, but nobody seems to know!  The doctors don’t know, NDSS won’t respond except for a big NO, where to next????  Can anyone help /advise me here?  I have two more appointments, one with Diabetes Clinic (and no, the diabetes educator doesn’t know either) and one with my GP, over the next two weeks or so – hopefully it will get sorted!

Perhaps, on either the 31st August, or six months later, I’ll just have to say oh, sorry, I’ve got to go home now because I’ve run out of my life-saving medications.

UPDATE 2 (29th July – one month pre-departure)

Finally got through on the phone line and was once again told only 6 months worth… Yes, I know that, so what options do I have?  Well she says, all I know is that you can only have 6 months … ah, yes, so what happens when I run out?  Well to give her credit, Angela went away to find out, and came back to tell me I could get 20% extra.  Hmmm, ok … and then?  Apparently when most people go overseas they find out about supplies available in-country, I somehow don’t think there would be many diabetics in Laos on insulin pump therapy – maybe I’m wrong but …

So now I have an email address and contact name to write to with my request.  Clearly my other email got lost somewhere along the line.  Again, wish me luck?

Email sent 29/7/16:

Att: Geeta

NDSS Membership No: 00xxxxx

I understand that NDSS supplies are limited to 6 months worth, however I have particular circumstances that necessitate a 12 month supply as follows:

1. CONTOUR NEXT – Blood glucose testing strips x 5/day= 1,850= 19 boxes (x100/box)
2. MiniMed Sure-T Paradigm 60cm, 8mm:  10per box: 1 every 3 days = total 122 = 13 boxes
3. Medtronic Reservoir Paradigm 10per box: 1 every 3 days = total 122 = 13 boxes

My local NDSS pharmacy is: Chemmart

89-97 Street Cnr Playne and Young Young St, Frankston VIC 3199

Some additional information in support of this request:

Annabelle Leve  is a volunteer who will be travelling overseas as part of the XXX program managed by XXX.

The XXX Program aims to strengthen the mutual understanding between Australia and countries in Asia and the Pacific, as well as make a positive contribution to development as part of the XXX program.

I would appreciate your consideration of this request, being mindful of my departure date on 31 August.

Thank you and regards, Annabelle

Later… A very quick response this time… as follows:

(not once have I been given an alternative – even if it means paying full price…)

Geeta Srinivasan <GSrinivasan@diabetesvic.org.au>	16:19 (2 hours ago)
to Mark, Angela, me

Hi Annabelle,

With regards to your request of products for 12 months;

The Commonwealth limits are a maximum 6 month supply, this equivalent to PBS regulation 24, which allows a script and 5 repeats as a maximum supply. There is NO provision under Commonwealth guidance for supply greater than 6 months for any registrant, regardless of circumstance

Any further enquiries need to be directed to Diabetes Australia on ndss@diabetesaustralia.com.au

Kind regards,

Geeta

Primary Care Engagement Officer

Diabetes Victoria

570 Elizabeth Street

Melbourne Vic 3000

Mobile:  0477 102 099

Fax: (03) 9667 1779

gsrinivasan@diabetesvic.org.au

Update 3 (5 August)

I have sent an email explaining my situation to the company that supplies the product, Medtronic Australasia – they responded on 1st August as follows:

Thank you for your email. It has been forwarded onto the Diabetes department and a representative will be in contact with you.

No news yet.

Tried making a complaint to the Commonwealth Ombudsman – they suggested diabetes Australia, NDSS, or maybe the health department?  Nicole said she would call back … but no.

Just wrote and sent the following email to Diabetes Australia:

To whom it may concern

I have copied below, an email I sent to NDSS and the response I was given.  I have been trying to resolve this issue for awhile now due to the circumstances described below.  I have received no assistance or advice as to what my options might be.  I am not in a position to return to Australia within 12 months from departure (31st August) but remain an Australian citizen with diabetes management requirements.  I’d appreciate some help/advice on this matter as soon as possible please.

(copy of email to NDSS Vic as advised after a number of phone calls, and their response)

So… I guess I’ll just have to keep waiting…

Update 4 (8 August)

A slightly more informative response from Diabetes Australia, but still a blanket no, unless: “if you were overseas as an employee of the Commonwealth, where product can be delivered to a consul or commission”

Good Morning Annabelle

Thank you for your email. Diabetes Australia administers the NDSS on behalf of the Australian Government. This includes oversight of product supply and implementation of limitations that apply to the provision of NDSS products as a Commonwealth program.

As you have outlined below,  you will be leaving Australia for a period of 12 months from the close of August and will be required to exit Australian territories with the medications and consumables to manage your diabetes.

All Australian citizens are able to exit Australian territories with a maximum of 6 months’ supply of medication or consumables as provided by a Commonwealth program, such as the NDSS or Pharmaceutical Benefits Scheme (PBS). Once you leave Australian territories, you are unable to access the NDSS or PBS whilst overseas. The only exception that would apply is if you were overseas as an employee of the Commonwealth, where product can be delivered to a consul or commission.

In your circumstance you are able to exit Australia with the maximum 6 month supply of NDSS items as outlined by the Australian Government.

There is no provision or allowance for a greater supply of NDSS items. This will equate to the following maximums:

• Blood Glucose Test strips –  900 strips (9 x 100 pack)
• Insulin Pump Infusion Sets – 9 boxes (90 units)
• Reservoirs – 9 boxes (90 units)

If you have any further questions, please contact myself or my team directly.

Regards

Darren

Update 5 (10 August)

Well, it’s about time this saga came to a close!  I had a most informative talk today with Dr Bob Cass, my sending organisation’s chief medical adviser.  Apparently he has been fighting for such cases for years and the government bureaucracy stymies any efforts to make any changes to the system, for any (legitimate) reason.  So now I know, that our government will not allow more than 6 months medical supplies to be obtained by any Australian citizen/taxpayer, which has the following potential impacts:

1. Anyone with a chronic condition that requires ongoing medical intervention/treatment is effectively prevented from volunteering/working/travelling overseas for more than 6 months at a time;
2. Is put in a position where they may cut/alter/change/stop medication because it is either unavailable or unaffordable to obtain;
3. Risk their long term health outcomes and potential need for emergency care or evacuation back to Australian Health care providers;
4. Break the law by ‘doctor shopping’ and filling prescriptions in different locations;
5. Stockpile medications in any way possible;
6. …

Next stop, my local Member of Parliament….

Final Update  (19 August)

Best advice?  Stockpile.  Eke it out.  Get as much as you can to take with you.  Use as much of the insulin as you can get out of the vial.  With the pump, extend to 4 days per change if possible.  Other meds – maybe I can halve my dose to last double the time.  Maybe I can buy some things in Thailand.  Maybe I can get any visitors to bring some supplies with them.  Or hey, self fund a return trip to pick up my next entitlement in 6 months time – an expensive and really quite unnecessary option.

But overall, none of this is ideal.  I am forced to play with my health in order to ‘serve the country’, as per Australia’s overseas aid contribution, for 12 months overseas because our health system will not allow for any reason to obtain more than 6 month’s supply of medication (or pump supplies).   In the long run, I suppose Medicare will pick up the bill for any long term health consequences.  Doesn’t make a whole lot of sense to me.

western-do-gooders-need-to-resist-the-allure-of-exotic-problems (from The Guardian)

Link to Guardian Article:  23 April 2016 

 

“But don’t go because you’ve fallen in love with solvability.

Go because you’ve fallen in love with complexity.

Don’t go because you want to do something virtuous.

Go because you want to do something difficult.

Don’t go because you want to talk.

Go because you want to listen.”

This piece was originally published on The Development Set

Courtney E Martin is a journalist and author of several books including Do It Anyway: The New Generation of Activists