Monday, September 29, 2008

Buy My Friend's Book: The Hans Schattle Edition


Sherman Oaks, California

Hans Schattle -- who secured a place in college newspaper lore by writing an auto insurance reform story which was more than 100 column inches long -- has published a book. It's a restrained 164 pages.

Yeah, Hans!

The Practices of Global Citizenship, published earlier this year by Rowman & Littlefield Publishers, is an elaboration of the doctoral thesis Hans researched and submitted while at Oxford.

Amazon can ship you a copy tomorrow, so what are you waiting for? Global citizens help each other out, right, Dr. Schattle?

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Thursday, September 25, 2008

American Writer


Final, comforting words to his countrymen.

"American Writer"

We don't speak the Queen's English -- no obligation to -- and we don't apologize for our traditions, our sounds, our broad vowels or glottal stops or any of the confusing, different words we use for cars.

That's them. We're us.

And we write and sound like us, not them.

Thank you, WSB, American Writer.

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The Paris Intifada


Sherman Oaks, California

Andrew Hussey, writing in Granta 101, provides a history and description of life in the bleak, post-modern "suburbs" of Paris:

Banlieue is often mistranslated into English as ‘suburb’ but this conveys nothing of the fear and contempt that many middle-class French people invest in the word. It first became widely used in the late nineteenth and early twentieth centuries to describe the areas outside Paris, where city-dwellers came and settled and built houses with gardens on the English model. One of the paradoxes of life in the banlieue is that it was originally about hope and human dignity.

To understand the banlieue you should think of central Paris as an oval-shaped haven or fortress, ringed by motorways – the
boulevards périphériques (or le périph) – that mark the frontier between the city and the suburbs or banlieue. To live in the centre of Paris (commonly described in language unchanged from the medieval period as intra muros, within the city walls) is to be privileged: even if you are not particularly well off you still have access to all the pleasures and amenities of a great metropolis. By contrast, the banlieue lies ‘out there’, on the other side of le périph. The area is extra muros – outside the city walls. Transport systems here are limited and confusing. Maps make no sense. No one goes there unless he or she has to. It’s not uncommon for contemporary Parisians to talk about la banlieue in terms that make it seem as unknowable and terrifying as the forests that surrounded Paris in the Middle Ages.

The banlieue is made up of a population of more than a million immigrants, mostly but not exclusively from North and sub-Saharan Africa. To this extent, the banlieue is the very opposite of the bucolic
sub-urban fantasy of the English imagination: indeed for most French people these days it means a very urban form of decay, a place of racial tensions and of deadly if not random violence.

* * *

The original meaning of banlieue dates back to the eleventh century, when the term
bannileuga was used to denote an area beyond the legal jurisdiction of the city, where the poor lived. In the late fifteenth century, the poet and bandit Francois Villon described how Parisians feared and despised the coquillards, the army deserters and thieves who lived on the wrong side of the city wall. As the city grew larger through the eighteenth and nineteenth centuries, the original crumbling walls of the Old City, now marking the city limits, became known as les fortifs or the ‘zone’. This was marginal territory, with its own folklore and customs, a world of vagabonds, rag-pickers, drunks and whores. This was also the fertile ground that later produced street singers such as Frehel and Edith Piaf,who dreamed and sang of le Grand Paris or Paname (slang for Paris), of the rich city centre only a few miles away from where they lived but as distant and alien as America....

During the
trente glorieuses, the period of rapid economic growth that occurred between the 1950s and 1970s, other major towns across France adopted the Parisian model of building estates far outside the centre. The first new developments in the banlieue were sources of pride to the Parisian, Lyonnais and Marseillais working class who were often grateful to be evacuated there from their slums in the central city. Once, long ago, the banlieue was the future.

I remarked on this to Kevin, a rangy black lad of twenty who, with his mate Ludovic (roughly the same age), was showing photographer Nick Danziger and me around the area. Both of them were obsessed with football, especially with the English Premier League. They were impressed that I had met and interviewed French footballers Lilian Thuram, who is black, and Zinedine Zidane, who is from an Algerian family. ‘I can’t imagine this as Anyone’s future,’ Kevin said, gesturing at the car parks and boarded-up shops. ‘All anybody wants to do here is to escape.’

Kevin himself is a footballer of average ability; he had a trial with Northampton Town in England. ‘I hate France sometimes,’ he told me. ‘And, at other times, I just stop thinking about it. But the real thing is that here, when you are born into an area and you are black or Arab, then you will never leave that area. Except maybe through football and even that is shit in France.’

I asked him about his English name. ‘I like England. And like everyone here, I don’t feel French, so why should I pretend?’

Ludovic, who at least has a more conventionally Gallic name but is originally from Mauritius, joined in. ‘They don’t like us in Paris, so we don’t have to pretend to be like them.’ By ‘them’ he means white French natives
Gaulois or fils de Clovis, in the language of the banlieue.

It is this Anglophilia, transmitted via the universal tongues of rap music and football, which explains why so many kids in the banlieue are called
Steeve, Marky, Jenyfer, Britney or even Kevin. They don‘t always get the spelling right, but the sentiment is straightforward: we are not like other French people; we refuse to be like them.

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Wednesday, September 24, 2008

Knife Tricks: Big In Brazil


Sherman Oaks, California

Good news: I am quoted at length in this article about adventure tourism, which was written by Paula Adamo Idoeta for Globo.com.

Bad news: It's in Portuguese.

Good news: I said something like:

I like to travel to unusual places in order to avoid the homogenizing effects of globalism. The more visited a country is, the more likely you could follow your daily routine as if you never left home. What's the point of that?

Countries are rarely hostile. A regime might have sharp disagreements with my government, or a specific neighborhood might have high crime and best be avoided, but it's inaccurate to classify entire countries as hostile. A famous example is the tendency of many middle-class Iranians to think well of the United States, regardless of the heat between the two governments.

Hysterical State Department and Foreign Office "travel advisories" are the worst offenders; two citizens are mugged on holiday, and the entire country is tarred for years as dangerous. Thailand during last week's "State of Emergency" and "demonstrations" was exactly like Thailand was every other day of the year. Frankly, bargain hunters should book a trip to Bangkok now; the news coverage has scared away tourists, and the hotels are responding by cutting rates.

My favorite trip so far was to North Korea. The country is a time capsule into a 1940s Stalinist regime. It is almost unrecognizable as a modern society. You see people working the fields by hand or with maybe one ancient Soviet tractor. There is no private outdoor advertising. There are numerous blackouts a day in the capital city of Pyongyang. Most people wear the same three or four cuts of clothing. And all North Korean citizens wear a red lacquer pin of national founder Kim Il-sung over their hearts.

Police states are the safest places in the world. Someone is always watching.

Statistically, the most dangerous thing a person can do is drive or ride in a car. Everything else is a distant second. So, no, I've never found myself in what I consider a dangerous situation. Common sense obviates 90% of problems, and some background research covers the other 10%. When in doubt, do what the locals do.

When my friends are nervous about travelling, I tell them that there are only about a dozen places on earth that are truly dangerous. But no one's taking a family trip to Baghdad or rural Liberia or the FARC-controlled Colombian mountains, so relax and enjoy the trip.

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Saturday, September 20, 2008

A Truism of Expat Life: It's About The Girls


Sherman Oaks, California

Khmer440 examined why certain nightclubs and taverns in Phnom Penh, Cambodia, had closed or gone out of business.

In the commercial showdown between the infamous Heart of Darkness -- where a patron was murdered -- and George's Nightclub and Kebab House, the Heart won. Why?

Intriguingly George’s tried to go head to head with the Heart for the elusive late night freelance dancing ladies custom and this high risk strategy actually worked during that time the Heart was closed for renovations.

Whilst everything was going to plan there would often be a multitude of steel panther SUVs crouching outside, and inside one would find wealthy Khmer men yakking nonsense while slurping jumbo jugs of Angkor beer, local manikin dusky disco dollies cavorting around poles and lots of old white blokes watching the disco dollies, jaws agape....

And then the Heart reopened and George saw the freelance dancing ladies return en masse. Rule one of owning a nightclub is this. The Western guys just go where the Khmer girls are no matter how dangerous the venue, no matter how rotten the music is and no matter how overpriced the drinks are. And the Khmer girls went back to the Heart.
Change the proper nouns, and it's true anywhere in the world. The Western men go where the local girls are. All other considerations are secondary.


Pictured: A patron of Q Bar Bangkok, the owners of which know what reels in customers.

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Friday, September 19, 2008

Cambodia Legal Internship Not Best Career Move



Sherman Oaks, California

A young, idealistic and peppy law student, looking for hands-on experience (and a resume booster), signs up for a summer in Cambodia working on land reform.

Asia hands know exactly where this story is going.

Our cuddly 2L vents to admissions guru Anna Ivey:


One problem is my colleagues and supervisors don't seem to do much. I nicknamed one attorney "man that stares at his cell phone" in honor of his 8 hour a day activity. The lack of work is partly due to the fact that government doesn't respond to motions, follow its own laws, or respect the court system. It's common to wait months for rulings, only to find out the court is "too busy" and will not issue any ruling at all, or the case file has been lost. As a result, the attorneys often wait around and do nothing.

I think my boss is depressed about the corruption. The program's two showcase lawsuits have been going on for 7 and 4 years respectively. In the first case, the local prosecutor has [allegedly] refused to correctly implement the presiding judge's verdict, and in the second case everyone involved in facilitating the [allegedly] fraudulent sale of indigenous land has admitted to taking bribes in a transaction that was, on its face, against the law (the land was sold to the sister of the Minister of Finance)....

I know that one of the themes of your blog is that Gen Y's self-involvement leads to unreasonable expectations and more than an acceptable level of complaining. So I decided to create a writing project for myself where I would investigate how to go about filing a complaint in US courts against a Cambodian-American that [allegedly] dispossessed 23 families using armed men and bulldozers. I thought several allied NGOs were representing the families. I went to the province and met with people from the 3 other NGOs, but no one spoke sufficient English to discuss the case. I had to get the moto taxi driver to translate, which of course didn't work since the taxi driver's English was limited to "right, left" and not "motion, complaint." Then I went and interviewed an American ex-pat restaurant owner who witnessed the seizure. He was smoking pot during the interview. Anyway, long story short the NGOs weren't representing the families anymore because they never had actual title to the land and the Cambodian-American is politically connected and [allegedly] paid an acceptable bribe to the local families. The memo, while a nice academic exercise, would be functionally useless. Instead I'm writing another grant proposal and shadowing my boss to his infrequent meetings with court officials (going to an hour meeting in the provinces can take 3 days after factoring in driving).

But that's it. I've got an interesting story or two about the outrageous facts in the cases, but I haven't done much substantive legal work. In on campus interviews, I can show an attorney a picture of a client meeting with a monkey in the background but not a legal memo.
Ms. Ivey gives some excellent and tactful advice.

My turn:

What the hell were you thinking?

Cambodia is listed by the United Nations as a Least Developed Country, which is diplo-speak for Most Screwed Up Places On Earth. A country gets off the list by posting a gross national income per capita of $900, and Cambodia can't swing that.

What were you expecting? France with banyan trees? Thailand with fewer Seven-Elevens?

Did you seriously think Cambodia would have a functioning court system? That Cambo judges would rule against government officials because a bunch of barangs started waving pieces of paper?

ROTFLMAO!!!!!!!!!!!!

Did you do any research into the reality of contemporary Cambodian society?

My biggest complaint about baby lawyers is that they know volumes of nuanced legal theory but don't understand the basics of how law works in reality. This proves my point in spades.


Pictured: The courthouse constructed specifically for the Cambodian genocide trials which, despite U.N. oversight, are a farce.

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Thursday, September 18, 2008

I Detect A Pattern


Singapore Changi Airport

Flights on Singapore Airlines leave from either Terminal 2 or Terminal 3 of Singapore Changi Airport.

Here's the way the departing flights are organized:

Terminal 2
Africa: Egypt, South Africa
Europe: Russia, Turkey
Middle East: Saudi Arabia, U.A.E.
South Asia: Bangladesh, India, Maldives, Pakistan, Sri Lanka
Southeast Asia: Brunei, Indonesia, Malaysia, Philippines, Thailand, Vietnam

Terminal 3
Americas: USA, Canada
Europe: Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Switzerland, U.K.
North Asia: China, Hong Kong, Japan, Korea, Taiwan
Southwest Pacific: Australia, New Zealand

I'm sure it's a coincidence that flights to developed nations are from sparkly new Terminal 3 (pictured), while flights to the less developed nations that provide Singapore's manual labor are from older Terminal 2.

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Miss Singapore Can't Get A Date


Little India, Singapore

I read it in the state-controlled media, so it must be true.

Twenty-one-year-old Muslim cutie Faraliza Tan, the reigning Miss Singapore World, can't get a date, because young men are too intimidated to ask her out, the New Paper on Sunday reports.

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Tom Friedman's "Neighborhoods" Analogy

Sherman Oaks, California

As we batten down for the Category Five gales of publicity supporting another globe-gobbling Tom Friedman book launch, let's remember the famous "neighborhoods" passage from his The World Is Flat.

Accurate? Glib? Memorable? Condescending?

You decide!

What if regions of the world were like the neighborhoods of a city? What would the world look like? I'd describe it like this: Western Europe would be an assisted-living facility, with an aging population lavishly attended to by Turkish nurses. The United States would be a gated community, with a metal detector at the front gate and a lot of people sitting in their front yards complaining about how lazy everyone else was, even though out back there was a small opening in the fence for Mexican labor and other energetic immigrants who helped to make the gated community function. Latin America would be the fun part of town, the club district, where the workday doesn't begin until ten p.m. and everyone sleeps until midmorning. It's definitely the place to hang out, but in between the clubs, you don't see a lot of new businesses opening up, except on the street where the Chileans live. The landlords in this neighborhood almost never reinvest their profits here, but keep them in a bank across town. The Arab street would be a dark alley where outsiders fear to tread, except for a few side streets called Dubai, Jordan, Bahrain, Qatar, and Morocco. The only new businesses are gas stations, whose owners, like the elites in the Latin neighborhood, rarely reinvest their funds in the neighborhood. Many people on the Arab street have their curtains closed, their shutters drawn, and signs on their front lawns that say, "No Trespassing. Beware of Dog." India, China, and East Asia would be "the other side of the tracks." Their neighborhood is a big teeming market, made up of small shops and one-room factories, interspersed with Stanley Kaplan SAT prep schools and engineering colleges. Nobody ever sleeps in this neighborhood, everyone lives in extended families, and everyone is working and saving to get to "the right side of the tracks." On the Chinese streets, there's no rule of law, but the roads are all well paved; there are no potholes, and the streetlights all work. On the Indian streets, by contrast, no one ever repairs the streetlights, the roads are full of ruts, but the police are sticklers for the rules. You need a license to open a lemonade stand on the Indian streets. Luckily, the local cops can be bribed, and the successful entrepreneurs all have their own generators to run their factories and the latest cell phones to get around the fact that the local telephone polls are down. Africa, sadly, is that part of town where the businesses are boarded up, life expectancy is declining, and the only new buildings are health-care clinics.
Paragraph breaks, Tom, paragraph breaks.

Monday, September 15, 2008

Can't Cancel Medicare Part B From Abroad

Incheon, South Korea

An anonymous commenter to Knife Tricks makes a point that bears emphasizing about how poorly expats are treated by the U.S. Medicare system:

I heard that the SSDI COLA was going to be substantial year... I also heard that the Medicare premium would eat most of it up.

since I could use the case I decided to cancel my Medicare Part B.

I am disabled, living abroad in Belize, and there's free healthcare here, so I don't need Part B. (I'm keeping Part A in case there's some future emergency, that seems wise)

but just TRY to cancel Part B from abroad!!

you can't do it .

your choices are, to phone a toll-free number, (USA 800 numbers don't WORK from Belize), or, an in-person visit to a Social Security office.

I'm not going to spend $1000 bucks for a round-trip plane ticket, just to have a ten minute appointment!

apparently, Social Security MUST discuss it with you, either on the phone, or in person, to explain the "ramifications" of such a choice (disenrollment is unsafe!)

geez, Louise, I am frustrated by this.

oh, and the special form for disenrollment (CMS-1763) is "privately owned" and NOT available online....


Medicare is not a health care guarantee for U.S. citizens. It's a payment guarantee for the U.S. health care industry. This becomes obvious when you try to take advantage of the lower costs of international health care -- and learn that Medicare (which, on paper, should seek to cut costs) doesn't want to let you.

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Sunday, September 14, 2008

One Reason For The Palin Pushback

Changi Airport, Singapore

Let me take advantage of the free internet at Singapore's airport to opine why a certain type of high-achieving woman hates Sarah Palin.

Palin made all of the "wrong" decisions.

She didn't spend her high school years grinding out a resume for the benefit of college admissions officers. She didn't attend a prestigious university. She didn't move to the Big City. She didn't devote her 20s and 30s to pursuing a high-paying or high-status job. She married a blue collar hunk. She had five children.

And she's now the most famous and successful woman politician in the country.

Thursday, September 11, 2008

Good Schools For Me But Not For Thee



Bangkok, Thailand

Sandra Tsing Loh rips off a bloody scab of American politics:

Liberal Democrats who want to condemn other people's children to failing public schools on the grounds of "equality and diversity" have a habit of sending their own kids to private schools.

The comments are particularly instructive.

"But isn’t it enough that I vote for progressive politicians, and support high property tax rates that pay for our schools?"

"I am also a passionate Democrat, a believer in the common good and the importance of shared responsibility, but don’t believe I can sacrifice my children for a possible benefit, later down the road."

"The research you cite, that there is no ill effect on the middle class children schooled with poor children, does it account for the social effects, the lack of networking opportunities afforded both the upper middle income parents and their children, the students?" (Emphasis added.)

Social equality is great, but we can't let it interfere with Cody's networking opportunities.

The petty hypocrisy of these parents is funny, but it's also tragic. Democratic dogma opposes vouchers (by which I mean the returning of tax money to parents to use on the educational method of their choice) in even the worst-performing districts in the country.

These parents support a political party that wants to entrap kids in terrible schools -- other parents' kids.

And people say Republicans are selfish?

Theroux on Singapore



Bangkok, Thailand

Travel writer Paul Theroux was interviewed recently by The Wall Street Journal. Irascible as ever:

"Singapore is an example of a place where people are self-conscious in the presence of foreigners, because they feel that you're going to criticize them for having accommodated themselves to their government and this way of living.

"It's like a gated community. You go in definitely feeling (a) that you don't belong there, (b) that they're not particularly interested in your staying there, and (c) that they're very, very defensive. They feel they have to explain why they've settled for Singapore. And do you know, the sex trade there is booming, but their boast is, 'These aren't Singapore girls . . . they're Burmese, they're Vietnamese, they're Filipina . . . but not us!'"

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Molar Madness: The Bill

Bangkok, Thailand

The final bill for the operation:

Anesthesia General: 2,150 baht (US$65.15)

Doctor's Fee: 36,000 baht (US$1,090.91)

Medical Equipment: 4,635 baht (US$140.45)

Medical Gas: 2,250 baht (US$68.18)

Medical Supplies: 9,485 baht (US$287.42)

Medicine: 11,248 baht (US$340.85)

Nursing Service: 1,750 baht (US$53.03)

Operating Room: 15,766 baht (US$477.75)

Room: 4,490 baht (US$136.06)

TOTAL: 87,774 baht (US$2,659.82)

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The Ghost by Robert Harris



The Ghost by Robert Harris (Simon & Schuster 2007)

It would be churlish to review a thriller as anything other than a work of entertainment.

Allow me.

The superlatives larded upon The Ghost are all earned. The novel is gripping, engrossing, exciting, seductive, delicious and all sorts of other words you see in big type on the cover of a mass market paperback. I read The Ghost in three days and would recommend it unhesitatingly to anyone who enjoyed political thrillers.

The story is about an unnamed ghostwriter hired to complete the memoirs of a recently retired Prime Minister of the United Kingdom. The current draft is turgid, the media baron who paid $10 million for it is becoming impatient, and, oh yes, there's the unfortunate fact that the first ghostwriter, a Downing Street coatholder named McAra, fell from a ferry and drowned. If the ghost will hie to Martha's Vineyard in winter – where the ex-PM is holed up at the media baron's waterfront estate -- and turn the manuscript into something publishable, he'll receive a quarter million dollars.

“And this is where, in that parallel life, I express polite sympathy for the elderly Mrs. McAra ('such a shock to lose a child at that age'), fold my heavy linen napkin, finish my drink, say good-bye, and step out into the chilly London street with the whole of my undistinguished career stretching safely ahead of me,” the ghost writes. Of course, he's actually on the next plane to Boston.

The ex-PM's name is Adam Lang, but author Robert Harris isn't playing it coy. The book is about Tony and Cherie Blair, and Harris damns with the fervor of a true believer who learned that his heroes were human after all – and this is where reviewing the book becomes difficult.

Harris uses the guise of a pulp novel – an excellent pulp novel -- to accuse the Blairs of complicity with U.S. war crimes, including torture and illegal rendition. One of the book's characters accuses Blair of treason and lays out the Bill of Indictment:

“'One: deployment of British tropps to the Middle East, against the advice of just about every senior commander in our armed forces and all of our ambassadors who know the region. Two' – up went his right index finger – 'complete failure to demand any kind of quid prop quo from the White House in terms of reconstruction contracts for British firms, or anything else. Three: unwavering support for U.S. Foreign policy in the Middle East, even when it's patently crazy for us to set ourselves against the entire Arab world. Four: the stationing of an American missile defense system on British soil that does absolutely nothing for our security – in fact, makes us a more obvious target for a first strike and can provide protection only for the U.S. Five: the purchase, for fifty billion dollars, of an American nuclear missile system that we call 'independent' but that we wouldn't be able to fire without U.S. approval, thus binding his successors to another twenty years of subservience to Washington over defense policy. Six: a treaty that allows the U.S. to extradite our citizens to stand trial in America but doesn't allow us to do the same to theirs. Seven: collusion in the illegal kidnapping, torture, imprisonment, and even murder of our own citizens. Eight: a consistent record of sacking any minister – I speak with experience here – who is less than one hundred percent supportive of the alliance with the United States. Nine --”

“ 'All right,” I said, holding up my hand. 'I get the picture.'”

As do we.

There's a point of specificity where an author can't hide behind the argument that “it's only a novel,” and, as you just read, The Ghost plows past that point with brio.

Harris can't prove his many allegations against the Blairs – as one of the book's characters admits -– but that hasn't prevented Harris from impugning the patriotism of the Blairs on the British bestseller list.

Harris' attack on the Blairs is one-sided, without an acknowledgement of Tony Blair's great calculation. The U.K. has a choice of being one of twenty-seven constituent parts of an ineffectual European superstate or of being partners with the United States and trying to change the world.

Blair chose to stick with the United States -- even if the U.S. was wrong -- because he made the judgment that the Atlantic alliance was ultimately best for the U.K. The political battles over the War on Terror are already receding – victory has a way of doing that – and Blair will be vindicated in the end, although not at the end of Harris' book (which provides a crackling climax).

Perhaps Harris pulled it off: He wrote a political poison pen letter in the guise of a thriller that's so good it gets judged warmly by the loose standards of popular fiction. But Tony Blair will, I am confident, be judged laudably by the stringent standards of history.

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Tuesday, September 09, 2008

No Pain

Bangkok, Thailand

No pain.

That's the incredible part.

I heard horror stories from friends about the post-operative pain. I've had almost none.

The worst was directly after the surgery, when the anesthesia was wearing off. They wouldn't give me a new painkiller until I was completely awake, so that was an uncomfortable hour or two. But then they gave me the good stuff.

Now, I'm on some sort of super-Advil, not a narcotic. There's a small amount of discomfort in the jaw, but that's it.

Dr. Narong is some kind of genius.

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The King's Motorcade

Bangkok, Thailand

I saw the King's motorcade!

Actually, it was an anticlimax.

I was about to cross the Sukhumvit road when I felt someone grab my arm. "King," he said. I noticed an unusually large number of police and the fact that there was no traffic in the westbound lane. The royal security didn't want people to be crossing the overpasses as the motorcade drive underneath them.

The motorcade was six cars, each painted a light yellow, the royal color. I didn't see the King. I couldn't tell which car the King was in or which car he was meant to be in. (By contrast, President Bush is usually in one of two limos, both of which are clearly presidential vehicles.)

No sirens. No press vans. No ambulance. No bomb squad. Nothing to tell you that the most powerful man in the country was riding down the street.

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Monday, September 08, 2008

Molar Madness: D-Day

Bangkok, Thailand

It became real when I lay down on the stretcher to be wheeled to pre-op.

Prior to that, admission to Bunrungrad Hospital was like checking into a hotel, albeit one that checked your vital signs.

But, as the orderly pushed me down the hallway, it hit me that, within the hour, I would in the operating room.

* * *

There was a blackout while I waited in pre-op. The hospital's back-up generators kicked in immediately. Still.

***

The anesthesiologist asked me a few questions. I answered.

She gave me a consent form. It warned about potential side effects, including "dreams or memories of intra-operative events." I signed.

***

I was wheeled into the OR. Massive round lights were attached to the ceiling by robotic arms. The room was larger than the ORs on television shows.

I moved from the stretcher to the operating table. I started to feel the anesthetic kick in. "It's working," I said.

The next thing I knew, I was struggling to regain consciousness. Dr. Narong was standing next to my bed grinning. "Welcome back," he said.

It was over.

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Recovering

Bangkok, Thailand

The operation took two hours and was more complicated than expected, but I've been discharged from the hospital and am in a hotel.

There's a lot less pain than I expected, but I'm weak and tired from the surgery.

I'll blog more once I've recovered strength.

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Saturday, September 06, 2008

Molar Madness: Hospital Admission

Bangkok, Thailand

Tick, tock, tick.

I'm sitting in my hospital room, watching the clock slowly run down. I was admitted at noon for a 6 p.m. surgery. So, for now, I wait.

Points:

-- I paid for the operation in advance. The hospital put a charge of 85,000 baht (US$2,575) on my credit card.

-- Most of the paperwork has my photograph on the top. The white plastic hospital wristband also has my photo on it.

-- The hospital room is better than many hotel rooms. The bathroom is large , with marble; it has a shower, not a tub. There's a sofa, a lounge chair and a patio. The minibar has fruit juices and sodas, no alcohol. Three room service menus are on the counter. There's a fair amount of cabinet and drawer space, but no closet as such. Three large complimentary bottles of water don't do me any good, since I'm under orders not to eat or drink anything after admission. The TV has about 40 channels and a DVD player.

-- I'm blogging on my new Asus eee PC 901. More on that later.

-- I made urine for the nurse. I felt very productive.

Those Saudi Work Hours Look Good To Me

Bangkok, Thailand

An interesting comment from a John Burgess on the Outside The Beltway blog:

I discovered rather quickly that working at State Dept., you could really be abused depending on your place of assignment.

In Saudi Arabia, for instance, not only did you have an eight-hour time difference -- your office is notionally closing just as Washington is notionally opening -- but the difference in local weekends -- Sat-Sun. in DC; Thurs-Fri. in the KSA -- meant you were basically on-call 24/7. No amount of extra work was going to get you overtime. At most, you might hope to outwork competitors around the world in the same grade and thus earn a promotion.

Then there's that annoying clash of cultural hours. Saudis tend to work and play at night. No one, other than perhaps doctors, would be at his office until late morning or early afternoon. That meant that an embassy employee was going to be working late if he had to deal face-to-face with Saudis. In fact, I had more dinners at midnight or later than I had at 7:00pm. But the embassy, as an instrumentality of the USG, had office hours of 8:30-5:00, less the wrath of Congress descend.

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Molar Madness: The Plan

Bangkok, Thailand

I admit myself to Bumrungrad Hospital at noon local time on Saturday, September 6, and the operation is scheduled for 6:00 p.m. that evening. I probably won't be able to blog for a day or two thereafter, and, when I return, it will probably be to test drive new synonyms for "pain."

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Friday, September 05, 2008

Bangkok Is Safe, Plus: I Visit The Demonstration, Plus: Some Background



Bangkok, Thailand

-- Anti-government demonstrators have occupied Government House in central Bangkok for a week, prompting several foreign governments to issue travel advisories. China warned its citizens against travelling to Thailand, as have Singapore and South Korea.

-- There is no need for alarm and no need to change travel plans. Bangkok is as safe as it is every other day. Outside of the immediate Government House area, there is no indication in Bangkok that the demonstrations are occuring. It is business as usual for tourism and commerce.

-- Technically, Bangkok is under a State of Emergency, which places the capital city under military control. The decree forbids assemblies of more than five people (which the thousands of protestors are ignoring) and forbids the media from publishing inflamatory material (to which the press is objecting). No curfew has been imposed, there are no troops in the streets, and the police presence has not increased. Thai businesses are lobbying to have the State of Emergency rescinded, because it sounds bad and scares people away. But, on a practical level, it is a non-issue.

-- I visited Government House today, and the demonstrations had the air of an outdoor music festival.

To reach the streets controlled by the protestors, I had to walk between two batteries of riot police who were stationed just outside the protest perimeter. The policemen were sitting on the ground, in the shade, avoiding the mid-day sun; they carried shields, but their holsters were empty. Nearby, soldiers in the Thai Army were practicing crowd suppression maneuvers. None of them said anything to me as I walked by.

I reached a protestor checkpoint. A long-haired kid who looked like he should have been in his dorm practicing "Freebird" asked why I wanted to enter. I said I wanted to blog about the demonstration. He frisked me for weapons and let me pass.

The protestors control the streets directly around Government House, and these paths were lined with vendors selling food, t-shirts, drinks, knick-knacks and what not. Tents and makeshift awnings were everywhere, since Bangkok is both sunny and rainy. As I walked closer to Government House itself, the purpose of the tents became more political and less commercial. In addition, medical tents were erected near the Government House gates, and I later noticed a line of ambulances parked just outside the perimeter.

The protesters had erected a stage on the Government House lawn from which they speechified. The happenings on stage were broadcast to various loadspeakers erected around the site. Two or three news vans were parked inside the grounds, although most were parked just outside.

The grounds of Government House had been converted into a warren of tents and makeshift structures composed principally of metal tubing and plastic sheeting. Thousands of people were there, mostly sitting quietly, waiting out the hottest part of the day. Toilet and shower facilities had been erected. Most of the doors to Government House itself were locked, and, as for the unlocked doors, I could not talk my way past the guards, by which I mean bearded Thai guys in Che t-shirts and bandanas.

The crowd was almost entirely Thai. I saw a handful of Westerners, most of whom were reporters. Thai photojournalists were everywhere.

The atmosphere was not tense; it was not violent or forbidding. Many Thais were amused at my presence, but the language barrier was enormous.

Frankly, the only thing that bothered me was the fact that Government House was ringed by a high fence with only a few open gates. If the authorities decided to rush the crowd, people would be trapped and crushed.

-- You can keep track of the day-to-day by reading The Bangkok Post or The Nation.

-- The 90-second version of what the hell is going on:

It's all about a man named Thaksin Shinawatra.

Thaksin was among the richest men in Thailand, having secured one of the kingdom's two principal wireless licenses. He was elected prime minister on a populist platform which appealed to rural voters and the urban poor, who comprised about two-thirds of the electorate.

The other one-third of the electorate were affluent and middle class Thais who lived primarily in Bangkok and could not stand Thaksin or his policies. After it became apparent that Thaksin would keep winning elections, the Bangkok elite had the military oust him in a 2006 coup.

Thaksin fled to London, but he kept his hand in Thai politics. A new constitution was drafted, the military stepped aside, new elections were held, and, to the disgust of the Bangkok elite, Thaksin's people won again and are currently in power.

So the demonstrators who are occupying Government House are a motley alliance of Everyone Who Hates Thaksin. Some are royalists, many support opposition party members, a few want a return to military rule, more are opportunists, and a critical mass of protestors I saw today are people who are living their personal 1960s.

-- This Wall Street Journal editorial adds more detail, if you're interested.

PHOTO: Reuters has been taking excellent photographs in Thailand, and this photo of the protestors in the early days of the occupation of Government House is one of the best.

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Molar Madness: The Internist



(Note: A series in which our hero details the process -- and costs -- of wisdom tooth extraction in Thailand. Previous posts here, here, here and here.)

Bangkok, Thailand

Dr. Wiwat couldn't conceal his boredom.

His job was to conduct an examination and determine my risk factor for general anesthesia. The answer was probably obvious to him as soon as I walked in, but hospitals don't make profits if they don't conduct tests.

For the next two hours, I was a baton in a medical relay race, as I was handed from doctor to tech to nurse to assistant, each leading me around the hospital or conducting a procedure or telling me to sit and wait.

These tests were conducted in Bumrungrad Hospital's "clinic" building, a temple to medical tourism (pictured). The sky lobby was on the tenth floor, and the general feel was that of a posh Hilton, with lots of light and tan marble. Video message boards provided information in English, Thai and Arabic script. Against one wall was the International Welcome Center, which consisted of about a dozen elegant desks with waiting employees. There was a decent book store in one corner, and a cafeteria upstairs offered cuisine from multiple regions. The desired ambiance was definitely Expensive Hotel; everything glistened.

Most of the patients were affluent Thais. There were also a few Westerners, one or two Indians, and the occasional grouping of Muslim women dressed in black chadors.

By this point, one fact had become obvious: to the male of the species, Bumrungrad was heaven on earth. The male-female ratio among the employees was easily 1 to 5, probably higher. Most of the physicians were men, while almost all of the nurses, assistants, clerks, orderlies and custodians were women. I should see if they need a staff lawyer.

Whenever I undergo a battery of medical tests, I have my Woody Allen moment, the point at which I am certain that the doctor will solemnly tell me to put my affairs in order.

With a state of mind tending toward funeral arrangements, I was returned to the visibly apathetic Dr. Wiwat (Mahidol University '81).

He thumbed through a stack of printouts.

EKG normal. Chest x-ray clear. Blood pressure normal. Heart rate 58 beats per minute. "Bony structures are normal." The CBC -- that blood test they always order on ER -- came back, but Dr. Wiwat's only remark was that my blood sugar was slightly elevated, so cut down on sweets and carbs.

In other words, I was fine.

"The risk for general anesthesia is low -- not zero -- but low."

I was free to go under the knife.


THE BILL

X-Ray: 300 baht (US$9.09)

Radiologist's Fee: 145 baht (US$4.40)

Doctor's Fee: 1,000 baht (US$30.30)

Cardiac Investigation: 525 baht (US$15.91)

Facility: 200 baht (US$6.06)

Laboratory: 1,770 baht (US$53.64)

TOTAL: 3,940 baht (US$119.40)

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Molar Madness: The "General" Surgeon

Bangkok, Thailand

He was the Big Swinging Scalpel. He was the Hawkeye Pierce, the Mark Craig, the Doug Ross.

He was Narong Lumbikanonda, DDS, and he was explaining what he would do to my mouth.

"The bottom teeth would be sectioned," he said, "sectioned" being dental talk for "sawed into pieces for removal."

Dr. Narong's job was the extracting of all four wisdom teeth in one procedure, with the patient under general anesthesia. He explained that I would have to be admitted to the hospital; people with a residence in Bangkok could have a day surgery, but travellers like myself should be admitted overnight.

On a scale of one to ten, I asked, how difficult was my surgery?

"Seven and a half," Dr. Narong said. The mis-alignment of my wisdom teeth wasn't that bad, all things considered, but I was 37, fifteen years past the optimal age for the procedure. As people grow older, the jaw becomes harder and the teeth become brittle. I really should have done this in my twenties.

While my worst tooth had a big root near a nerve, proximity isn't destiny. The most difficult situations, Dr. Narong explained, occur when the nerve is wrapped around a tooth's root. From the Panorex, that didn't seem to be the case with me.

But he noted, like the "local" surgeon had earlier, the possibility of numbness or a pins-and-needles feeling if the nerve coating were damaged, a condition named "paresthesia"; it could take weeks or months to heal and was a definite risk. He answered my questions about the "dry socket" complication (less than 5% of patients) and post-operative infections (nil).

I considered Dr. Narong's qualifications. He obtained his dental degree in 1983 from Bangkok's Chulalongkorn University, where he teaches in both the graduate and undergraduate programs. He earned a master's degree from The Ohio State University and a Ph.D. from Birmingham University in the U.K. He is a co-author of the page-turner "Comparison of osteoblast spreading on microstructured dental implant surfaces and cell behaviour in an explant model of osseointegration: A scanning electron microscopic study." This guy knows something about pulling teeth, I concluded.

I decided to have all four out at once. The procedure under local anesthesia sounded like hell: take two out, simmer in pain for a week, take the other two out, repeat. Let's get the misery over with.

I asked Dr. Narong for an estimate. He said the medical component would cost about 50,000 baht (US$1515), with other charges as well. He also wrote me a prescription for three more pills of Arcoxia. They certainly are frugal with the painkillers over here.

The cashier gave me a menu of hospital housing options, which ranged from a room shared among four patients to a luxury suite. I opted for a single room at a daily rate of 6,205 baht (US$188), similar to what a high-end hotel would charge in central Bangkok.

Finally, I was presented with a Letter of Estimate Cost, which contained the following estimates:

Surgery: 25,000 - 30,000 baht (US$758 - US$909)
General anesthesia (2 hours): 60,000 baht (US$1,818)
Single Room: 6,205 baht ($188)

Total Estimate (not including room): 85,000 - 95,000 baht (US$2,575 - US$2,878)

And then there was the bill for this session:

THE BILL

Dentist's Fee: 800 baht (US$24.24)

Dental Supplies: 150 baht (US$4.55)

Facility: 200 baht (US$6.06)

Medicine: 258 baht (US$7.82)

TOTAL: 1,408 baht (US$42.67)

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Trans-Pacific Routes: Where The Customer Has Real Choices



Bangkok, Thailand

One of the reasons, I suspect, why the South Korean carrier Asiana Airlines changed my return flights without a fee was because I have real choices when flying across the Pacific Ocean.

Many U.S. flights end with the purser reciting a line about how happy the carrier is for your business because "we know you have a choice of options when you fly."

Balls, as the Brits would say.

On many U.S. air routes, you have no choice at all. Many city pairs are serviced by exactly one carrier, particularly when one of the cities is a hub. There are a lot of places you could fly from Cincinnati, Ohio -- as long as you like flying Delta.

The existence of several airlines on a route is no guarantee of meaningful choice, either. The "Big Six" U.S. legacy carriers are depressingly similar in their mediocrity. Quick, what's the difference between American and Northwest? Different logos and liveries, as far as most people can tell. Plus, ticket prices tend to be identical. It's all oatmeal, no sugar, no spices.

"Choice" in the context of U.S. domestic air travel exists only if a low cost carrier competes with a legacy carrier on a route. Southwest provides a palpably different product than Continental. But that's a choice with only two options.

Trans-Pacific routes, however, are a shopper's paradise. I could buy a rock bottom economy fare on China Airlines (which is actually Taiwanese), splash out a bit for the upgraded Evergreen service on EVA Airways, or live highest on the hog with Singapore Airlines. There's always a deal available from Philippine Airlines or Air India, Korean Air receives decent reviews, and I've enjoyed the attention to passenger care on All Nippon Airways. Several Chinese carriers can take you to the People's Republic, or you can go old school by flying Cathay Pacific through Hong Kong.

A dozen different airlines can move you and your luggage across the Pacific Ocean, offering different levels of service, different strengths and weaknesses, and different price points.

That's real choice. When faced with it, airlines start to treat their passengers well -- and they stop levying niggling charges for things like meals, checked bags and schedule changes.

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Thursday, September 04, 2008

Molar Madness: The "Local" Surgeon

(Note: A series in which our hero details the process -- and costs -- of wisdom tooth extraction in Thailand. Previous posts here and here.)


Bangkok, Thailand

This is the part where I'm warned about nerve damage.

I consulted with Dr. Dheera Ratanasakdi (Mahidol University, '78), an oral surgeon at Bumrungrad's Dental Center. He confirmed what I had been told that morning and, at my request, ordered a Panorex, which is an x-ray of the entire mouth.

The verdict: my wisdom teeth were screwed, although, interestingly, the worst tooth didn't hurt. But, even as a layman, I could see on the x-ray that my lower left wisdom tooth was (1) sideways and (2) encased in bone. Great.

What I did not see as a layman was the light line running vertically near the roots of the worst tooth.

"That's a nerve," Dr. Dheera said, "and that's what I need to warn you about."

In a wisdom tooth extraction, the coating of that nerve can become damaged. It heals, but, in the meantime, the patient can feel a numbness or a pins-and-needles sensation that lasts days, weeks or even months.

"It is painful?" I asked.

"No, but it's annoying," Dr. Dheera responded.

Dr. Dheera explained that he specialized in extracting wisdom teeth under local anesthesia, two teeth at a time. Removing all four would take about two weeks. He estimated a total cost for his services of about 20,000 baht (US$610). He also recommended that I consult with a different oral surgeon about having all four teeth removed simultaneously, which requires general anesthesia and admittance to the hospital.

He prescribed an antibiotic for the infection (ten 1 gm Augmentin tablets) and a more powerful painkiller (three 120 mg Arcoxia tablets -- which is not approved for use in the United States). Three painkiller tablets; this ain't Los Angeles.

As before, the entire procedure took less than one hour from start to finish.

THE BILL

Panorex: 500 baht (US$15.15)
Radiologist's Fee: 150 baht (US$4.55)
Dentist's Fee: 800 baht (US$24.25)
Dental Supplies: 150 baht (US$4.55)
Medicine: 1,268 baht (US$38.42)

TOTAL: 2,868 baht (US$86.90)

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Molar Madness: The First Dentist Costs $20

(Note: A series in which our hero details the process -- and costs -- of wisdom tooth extraction in Thailand. Previous post here.)


Bangkok, Thailand

"Good, he's old," I thought, appraising the Thai dentist. "Old is good."

The discomfort in my jaw had increased daily, to the point where I knew in my gut I would have to cancel my planned Dith Pran Memorial Visit to the Cambodian Killing Fields and, instead, stay in Bangkok, paying penance for decades of oral sin.

So, after a night in which I could not sleep due to the pain, I went straight to the Dental Center at Bumrungrad International Hospital. Although Bumrungrad is the Western expat's hospital of choice, most of the patients in the waiting room were affluent Thais bringing their kids. An excellent sign -- when ill on the road, go where locals with money go.

I explained my situation to the woman at the registration desk -- her English was serviceable -- and she told me to wait. After about seven minutes, I was called in.

Dr. Sukhum Thiradilok is a 1969 graduate of Mahidol University's dental program, meaning that he's been a dentist longer than I've been alive. Score.

I explained the problem, and he examined my teeth and called for an x-ray of the painful area. After the film arrived, Dr. Sukhum explained that a vein of discoloration behind the right, lower third molar was an infection caused by trapped food. He also explained that my wisdom teeth were generally misaligned, exerting pressure within the jaw.

Dr. Sukhum advised that I consult with an oral surgeon, which I agreed to do. He wrote me a prescription for ten 500 mg Tylenol tablets. (As I'm discovering, Thai doctors are chary about prescribing pain medication.)

After the examination, a hospital employee handed me a document which contained a service number. I walked the document down to the second floor and handed it to a cashier, who finalized an itemized invoice. I paid in cash -- credit cards also accepted-- and then waited less than a minute. A pharmacist called my name and handed me the prescribed medicine.

The entire procedure took less than one hour.

THE BILL

Dentist's Fee: 420 baht (US$12.73)

Dental Supplies: 80 baht (US$2.42)

Facility: 120 baht (US$3.64)

Medicine: 30 baht (US$00.91)

TOTAL: 650 baht (US$19.70)

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"Travel is sold as freedom, but we were about as free as lab rats."

Heathrow the next morning looked like one of those bad science fiction movies "set in the near future" after the security forces have taken over the state. Two armored personnel carriers were parked outside the terminal. A dozen men with Rambo machine guns and bad haircuts patrolled inside. Vast lines of passengers queued to be frisked and X-rayed, carrying their shoes in one hand and their pathetic toiletries in a clear plastic bag in the other. Travel is sold as freedom, but we were about as free as lab rats. This is how they'll manage the next holocaust, I thought, as I shuffled forward in my stockinged feet: they'll simply issue us with air tickets and we'll do whatever we're told.


From The Ghost by Robert Harris (2007).

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Wednesday, September 03, 2008

Q & A: Why I'm Stuck In Bangkok For Two More Weeks


Bangkok, Thailand

Where the hell are you?

I'm in Bangkok, Thailand.

What are you doing there??

Waiting for surgery.

WHAT? Are you OK?

More or less. I was told 15 years ago that, if I didn't have my wisdom teeth removed, they would cause a problem one day. That day has arrived.

What happened?

On the flight from Los Angeles to Seoul, the right side of my jaw started to hurt, way in the back of my mouth. Over the next several days (while I was in Singapore), the pain became worse. I was in Bangkok, en route to Cambodia, when the pain became so great that I saw a dentist.

What did he say?

Exactly what I anticipated. The pain was caused by an infection, from food trapped by a partially erupted wisdom tooth (also called a third molar). Plus, the misaligned third molars were creating pressure on the good teeth.

Was the infection treated?

Easily. A week of antibiotics and some low-level pain killers.

So why are you having surgery?

To remove all four wisdom teeth.

You're doing this in Bangkok!?

Yes.

ARE YOU OUT OF YOUR MIND?

Not at all. Thailand is a center of "medical tourism." Thailand has some excellent hospitals, and they market their services to Australians, Japanese and others who want to avoid the stratospheric health care costs of their home countries. Dentistry is a significant part of the global business.

As it happens, I've previously been treated in Thai hospitals and was pleased with both the results and the price.

Where will you be going under the knife?

Bumrungrad International Hospital. It's fair to say that Bumrungrad is one of the best hospitals in Asia. Here's a first-person account of a stay.

Why don't you fly back to the United States and have the operation at home?

What's the point? I'm here, I need to (finally) deal with this, and it will cost less than in the United States.

Are you going to blog about this?

In detail. Stay tuned please.

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Another Reason Why Asian Airlines Rock



Bangkok, Thailand

I had to change my return flight to the United States, for reasons I will blog about later. I had purchased a bargain basement, non-refundable fare from Expedia, so I was apprehensive about additional fees as I approached the Asiana Airlines offices in the Ploenchit Centre Building on Sukhumvit soi 2.

Turns out, I had forgotten that I wasn't in the States anymore.

Cancellation fee: $zero

Change fee: $zero

Difference in fares: $zero

With this one gesture, Asiana has earned my repeat business.

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