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                A Psychiatrist's Journal


                 A cultural and psychiatric immersion/Tsunami relief                    By Elizabeth A. Garcia-Gray MD


    (Reprinted with permission of Dr. Elizabeth A. Garcia-Gray).

In February 2005, I planned, managed and coordinated the project for Dr. Garcia-Gray.  Her journal accounts and work with Tsunami victims was truly stellar.  Dr Garcia-Gray is a true humanitarian. For this reason, I recommended that she be awarded the American Psychiatrist Association Distinguished Fellowship.  Dr. Garcia- Gray’s experience and her journals will soon be published. Visit her web site at:


March 20 - April 2, 2005

The tsunami devastation shocked the world. Especially when it hit places and people who were innocently unprepared for the devastation. The countless number of lives lost all at once, and the children and families left behind and displaced, struck a resonating compassionate chord in many of our hearts. It certainly did in mine.

How quickly, much too quickly, life comes and goes. "One day at a time" becomes an even wiser and more pertinent saying. We ask our "whys?" And then we all observe how the majority of the world responded with much kindness, empathy and a compelling desire to help those who are suffering. For many of us understand deeply the meaning of a tragedy; the meaning of loss and agony. Thus comes the feeling of love to serve others. To ease their pain the way we wanted our souls comforted during sorrowful times. Hopefully to bring sparks of Light in the midst of some darkness.

In Emily Dickinson's “Not in Vain”, she sensitively described the hearts of volunteers around the world:
If I can stop one heart from breaking,
I shall not live in vain.
If I can ease one life the aching
Or cool one pain
Or help one fainting robin
Unto his nest again
I shall not live in vain.
That was how I started this journey. It was a journey of the soul.

And that was also when my research to help in some little way started. That took on a life of its own. From donating to various non-profit organizations in Network For Good to getting daily alerts regarding the status of countries affected by the tsunami from CIDI - Center of International Disaster Information. I also contacted several non-profit medical organizations, but they required a stay of at least 3-6 months and I only had 2-3 weeks of vacation time to give. Many volunteers globally did the same. Even the children and teens throughout the world wanted to do something. A worldwide outpouring of volunteerism.

My job as chief medical officer, of the child psychiatric services, for Seven Counties services a comprehensive mental health care non-profit organization was a mission in itself, serving people in the Louisville community. One organization called and asked me whether I could volunteer in Chad to work with the Sudanese Darfur refugees, but again, they required at least a three-month stay. If that were not possible, they wondered if I could go to Indonesia within the week, but I was booked solid with patients then and needed time to get back-up child psychiatric coverage in my organization.

At one point, I was almost headed toward Sri Lanka since I knew a team of doctors going there for short-term work. But somehow I ended up reading about Global Service Corps (GSC) in the “New York Times”, and that they had mission projects for two weeks in Thailand. I was also becoming more compelled to go to Thailand because I was impressed by the interview on the news of Thailand's prime minister. He requested help not necessarily on a monetary level but for expertise especially in the psychosocial aspects to rehabilitate the emotional damage caused by the tsunami. Not too often do you hear the government of a developing country say that they had enough donations for now and seek what their people truly need.

So, I contacted GSC, but they said that I was a bit late for the project. I had already booked my plane tickets ahead of time and had already scheduled my patients around those dates. It would have been logistically difficult to change the schedule. GSC then re-directed me to e-mail their In-Thailand Director. Interestingly, GSC stated on their website that they were mainly project-oriented in terms of volunteers working in hospitals and clinics or teaching English, with Buddhism immersions, but not necessarily able to help those wanting to volunteer for the tsunami-affected families. This was mainly because their project base was in Kanchanaburi, a province in Central Thailand. They work with medical students and physicians who want to do volunteer work in Thailand or Tanzania, where they have their projects.

Somehow, after many e-mail exchanges with GSC’s Thailand Director, Bruce, he was able to find ways to coordinate for me to have an initial cultural and professional immersion in Kanchanaburi with a Thai host family. After that, he organized a way for me to be escorted to the Phuket area affected by the tsunami in the south of Thailand. He had contacted Dr. Kung, an OB-GYNE doctor in the Pahon Hospital there, and she and her family would serve as my Thai hosts.

Dr. Kung and I exchanged e-mails and photos, and even through our e-mails, her warmth and down-to- earth ways shone through. Bruce also said that I could spend time meeting with a monk in one of their wats (monasteries). It was important for me to understand the religious and spiritual core of individuals and cultures as it sets the standard norm in understanding their sense of ideals and basic hope. In psychiatry, the sense of hope and faith are key to mental health resilience.

I then spoke with my adult children and family about the trip and showed them the photos of my Thai host family and the detailed and helpful schedule that Bruce e-mailed me. These helped allay their concerns. Bruce wrote me the descriptive details of who would meet me at the airport. Supposedly, a petite lady named Lek, with a red Chicago Bulls baseball cap, would meet me right after I got my baggage.

And I enjoyed the narrative of how he ended up in Thailand and along the way married his Thai wife. But most of all, it was heartwarming for him to remind me that the Bridge on the River Kwai was in Kanchanaburi. All of a sudden, I found myself whistling to the tune of the movie's main melody. The Bridge on the River Kwai was a famous movie that won many awards when I was growing up. And that movie reminded me nostalgically of happy childhood times with my beloved grandparents. Bruce was inspired by the book the movie was based upon.

I then went with the flow and sent the necessary paperwork to GSC that included copies of my passport, my medical credentials and resume, background information, personal mission statement and other necessary data. After I paid my fees, GSC sent me a hard copy of information about the trip, which included a checklist of what to pack and bring.

My family, friends and colleagues couldn't be more supportive. Some gave me little gifts to give the tsunami-affected families. My heart would sporadically beat faster thinking about going to Thailand. In reflecting upon my other previous global missions, I always came back with a much fuller heart and spirit. I gain perspective about my priorities in life. Crystal clear insights about love and life supplant the previously hazy ones. And what I originally thought as stressors before going on missions became just but a minor nudge in the bigger scheme of things.

And as my favorite writer, the Lebanese poet, author of “The Prophet”, Kahlil Gibran profoundly yet simply mused, "The sea that calls all things unto her calls me, and I must embark."

The following are excerpts from my journal when I was in Thailand.

March 27, 2005, Sunday

The drive to the tsunami area - Takuapa Hospital- Khao-lak

3am sharp. Both Att and Sert, my GSC staff and coordinators, were right on time. I said my good-byes to Dr. Kung and her husband and gave them my formal wais and then I gave them both a hug. I thanked them for everything and requested for them to please give the kids a hug for me. The children and their grandma were fast asleep during those wee morning hours. I just couldn't thank them enough for everything.

I missed them all already as we drove out of their home. I couldn't have been matchedup with a better family.

Att and Sert are such a gentle and very thoughtful couple. They tended to cater to me and I felt totally cared for in every way. They bought me lots of Thai goodies for the trip - bottled water, tangerines, coffee-flavored peanuts, and a treat that tasted like ice cream waffle cones. We stopped virtually every three hours for pit stops. The heat was intense and we were sweating all over. My face was drenched and my hair was just frizzed-up. Oh well. It would intermittently rain. Artificial rain made by the king to help with the drought. The toilets were tricky- very low on the ground. Frankly, I wasn't quite sure how to use them and too embarrassed to ask Sert and Att. They had pails to pour water into the hong narm ( toilet ) - which was bedpan-like in style.

We grazed and ate. Att even tried to get some tamarinds for me right from the tree. She found a thin branch and tried to pick at the tamarinds until they fell to the ground. It reminded me of my childhood days doing just the same thing with a fruit called sampaloc in the Philippines. I wondered if they came from the same fruit family.

The scenery driving from Kanchanaburi to Khao-lak was absolutely breathtaking! Mountain after mountain. They looked like soft pastel paintings in dark purple, lavender, pinks and peach. It got greener and more lush as we got to the South. We then ended up in a place called Pra-chuap. What a soulful place. Dreamy. It was lovely to see the beach right next to mountains. We stopped to take photos and then ate brunch in a nice hotel named Had Thong Hotel (Golden Beach Hotel). I loved those little round pancakes with coconut cream. And more exotic tropical fruits.

We then proceeded to Sukhothai and after several more stops, we finally ended up at the Takuapa Hospital. There was a nurse there named " Oyl" who we had to meet and who was in charge of organizing the tsunami relief situation in six provinces there. Oyl was very friendly and helpful. We toured the hospital and it was open and breezy. I welcomed that cool breeze. It was a white building much like the Pahon hospital but perhaps a little smaller. We were offered some cool drinks and that quenched our thirst in that heat. Sert and Att coordinated my schedule for the next few days with Oyl. There was a room there especially for tsunami relief conferences which had maps of the tsunami affected areas and the updated numbers of displaced children and families, the tsunami death toll, whether the injured and dead were Thai or foreigners or whether they couldn't tell the race from the extreme decomposition of the bodies.

We then tried to find our hotel. It was a long drive. Roughly 14 hours. The hotel was in Khao-lak in the province of Phang-nga. The area was the most tsunami devastated of all the regions there. We finally found our hotel - the Khao-lak Bayfront Hotel. My room number was 204. Beautiful place. Right on the beach. We walked around and explored the hotel grounds and sadly saw the devastation by the beach. Half of the resort was going through reconstruction. It was eerily quiet. On the left at the back of the hotel, by the beach, were homes with roofs that had been unshingled from the tsunami. Some debris on the beach. They had flattened out the back area of the hotel towards the beach and had replaced it with new soil that appeared to be pinkish -orange brown in color.

The area was quiet and private. A haven. Att, Sert and I walked around and took photos of an incredible sunset. We literally watched the sun go down. We did some walking meditation all around the area that was literally wiped out by the tsunami. I prayed for those who died and whose families were affected as well. I felt tearful. I couldn't even imagine how those people must have felt when the wave hit. Most of them were quite relaxed and vacationing when it all happened. I contemplated about how life was way too short and how it can be taken just like that. Within a second. And how important it was to live one day at a time. One moment at a time if possible.

Many died in the hotel we stayed in. From the beach one can see the overview of the hotel. The lower level was flattened out and the higher level remained quite intact. And from that view, one can easily see the awesome lushness of the mountainside with all the tropical trees. Many coconut trees. Incredible trees that couldn't be uprooted by the tsunami. The power of flexibility, rootedness and pliancy.

There were many settlement homes built and being built just down the road. Many businesses were closed. We did some souvenir shopping. Mainly for postcards for my children and some wrap around Thai silk skirts. When we came back to the hotel I couldn't wait to jump into the shower. It was probably the longest shower I've ever taken. I relished all that water all over me. Fresh again. It felt great! The hotel room was quite nice. I had a king-sized bed with the softest sheets I've ever slept in. It felt wonderful! There was also a balcony.

I wrote some postcards, journaled, watched a little tv, mainly trying to understand Thai, and went off to sleep. Approximately fourteen hours of driving from Kanchanaburi to Khao-lak was tough tempered only by the great company I had with Sert and Att , the wondrous scenery along the way and the thought of serving others out there. Being there was like being in the midst of a tropical rain forest and also a beach. Everything one can ever want from nature. No wonder people travelled from afar to vacation there. Paradise-like.

Somehow that night, we also managed to eat in an open-air restaurant. Thai curry on grilled fish; chicken with a special Thai sauce and rice. It was good to know Sert and Att even more. They were so soft-spoken and practically talked to one another in a whisper. I liked that. They were easy on the soul.

The next day, we were due for an orientation about the tsunami relief at 8:30 AM. So we had to leave at 8 AM. Breakfast at 7:30 AM. Yawning. The softest white sheets beckoned me. Necessary rest to have more energy for tomorrow's service work.

I prayed, meditated and serenely slept.

Match 28, 2005, Monday

In the heart of the tsunami mission

Breakfast with Att and Sert on the hotel balcony. It was sad to overlook where the tsunami hit. We could see the beach from the balcony. Thirty-eight foreigners (farang ) died in this hotel. The forty lower rooms of the Khao-lak Bayfront Hotel were demolished.

After breakfast, we drove off to Takuapa Hospital. We met Oyl, the nurse in charge of helping organize the tsunami conference. In the conference there were around fifty or more people - nurses, tsunami volunteers, psychologists, public health experts and the only psychiatrist in the Phang-nga region area serving more than 250,00 catchment population.

The public health man named Tik-ki did the presentation and showed us an excellent power point of photographs of the tsunami before and after the disaster. He showed us how much rehabilitation and reconstruction was being accomplished post tsunami. The pictures he showed were quite moving, graphic and he drove his point across. He told me later that he gathered those photos from various people and locals who witnessed the tsunami.

The volunteer nurses were all wearing bright pink. Everyone sat around a huge conference table. After the presentation, the young, attractive and bright psychiatrist and I spoke. She was very open to being shadowed when she worked and welcomed the consultation and the teaching.

Dr. Naiyana's English was quite good so we were able to communicate fairly well. We talked about the tsunami in general and about Psychiatry in Thailand

as well as in the USA.We also addressed the issue of the children and families in the settlement camps and she arranged for us to go there. She spoke with the rest of her team from Phang-nga Hospital and then we all went out together for lunch. They took us to a restaurant where they said the locals loved. And the food truly was delicious. Aroi.

Dr. Naiyana was a 27 year old psychiatrist who was trained in Bangkok but was born and raised in the northeast of Thailand. She was still single and the youngest of three siblings. She said that her parents visited her often. She also alluded to the fact that most of her psychiatric in-patients were merged with the surgical ward patients. She generally stabilized the acute patients and then sent the more chronic ones to a psychiatric hospital elsewhere.

It was enjoyable meeting the vibrant team. They were very collaborative and explained what they did in the rehabilitation phase of the disaster. They drove around in a van to visit one settlement site to another. Dr. Naiyana joined the team on Mondays to visit the camps as part of her work schedule. The public health man who did the presentation, I found out later, was an avid soccer fan.

So we talked about that in the van on our way to the camps. He articulated that anyone who loved soccer was a friend of his. Great then! Well, my experiences in Spain came in handy. We talked about Johann Cruyff from the Netherlands and Pele from Brazil , my favorite soccer players of all times. And how I was so impressed by the way Johann Cruyff played soccer and the way he just handled the ball so adroitly.

I recalled times in Spain when literally everything stopped when there were soccer games. And I remembered having gone to a Barcelona soccer game and saw Johann Cruyff do his magic. We talked about all these on our way to the Phang-nga Hospital. I requested Tik-ki if I could have a copy of his powerpoint presentation to share with other psychiatrists at my work in Louisville and he said that he was more than happy to do it. I appreciated it a whole lot. Sert and Att were surprised that he easily offered for us to have the powerpoint. Tik-ki also kindly made a copy for them.

Prior to that, we all went to see the children and displaced families in the settlement camps. There were knock-down temporary aluminum houses. Some houses were made of wood. Most of the families were under the make-shift houses to shield themselves from the heat that day. They moved slowly and quite languidly. The heat. They quietly spoke with one another. There was an older lady who appeared to be the matriarch of the family, and the nurses told me that she had a near-drowning during the tsunami and somehow miraculously survived.

There were 5 nurses to 68 people. They have the basic medication necessities - Tylenol, alcohol, antibiotics like Amoxicillin. Their medication shelf also contained some band-aides, gauze, and a first aid kit. The nurses were stationed underneath a temporary home and appeared to all be in generally good spirits. They were smiling and were very helpful when asked about what happened if there was an emergency when they were not there. They reported that they wanted to preserve the autonomy of the families and a wise elder usually took charge in calling the nurses when there was any emergency.

They also had a make-shift recreation area. Several children and teens were quietly painting on cloths. Tsunami themes. Like batik. I mingled with some of the children and teens who were silently painting. There were finished paintings hanging to dry everywhere. The colors they used were bright and grabbed one's attention. I quietly sat beside them as they worked on the batiks. I didn't want to intrude on the teens as they were so focused and engrossed in their art work. One teen did say that he "enjoyed" painting the tsunami. Art therapy in action. My sister Marissa,  an art therapist would be very pleased. The teens were very subdued. Very quiet. The younger children were playing in a playground. Their movements were slow. Voices - soft. Their faces sad.

The idea of teaching the children and teens to paint their interpretation of the tsunami disaster on batik cloths , I felt, was therapeutically brilliant! Not only were they able to express their feelings via their art works, they were also able to sell them to tourists as a means of livelihood. This then helped with their sense of autonomy and resourcefulness.

The nursing staff who were all smiles said that they had been there since right after the tsunami just hit and had many stories about the children's dilemma. Many upper respiratory infections among the families. Also allergic rhinitis. Many children had been depressed and the staff work on keeping them busy to alleviate their grief and sadness. A lot of the comforting and therapy were done by the nurses in many cases. There were many stories about near-drownings and about wounds and infections from abrasions and lacerations.

The Ministry of Public Health had been very efficient and effective in being on top of the tsunami situation there. They currently have potable drinking water and they have enough food that was sanitary. They were proud that there had been no water-borne illnesses nor outbreaks of diarrhea, vomiting nor nausea. They've contained a lot of that. The public health had been very quick in responding to the needs of the affected families.

Dr. Naiyana also said that the king's royal soldiers - his army - had been extremely helpful to the tsunami-stricken families. They did a lot - from taking care of the dead bodies, to cooking for the displaced families. The team was very respectful and grateful for the way the Thai soldiers had been helping out.

We passed by several places on the road that housed the many volunteers from all over the world. Habitat for Humanity, World Vision , UNESCO were all there. It was amazing to me how many coconut trees stayed rooted, while the buildings were demolished. There were many landspaces and moist soil areas where the tsunami struck alternating with areas of construction.

The Thai want the tourists back. The economy there was booming before the tsunami. One of the king's nephews died during the tsunami right in the Princess hotel resort that they recently built.

We finally drove to Phang-nga Hospital. Dr. Naiyana had a spacious office in the hospital with her own bathroom. She then took me to meet a 10 year old Moslem boy who was having paranoid delusions and hallucinations since the tsunami. She requested consultation about this boy as she was baffled by his symptoms. Post-traumatic stress disorder with psychosis. The boy was accompanied by an extended family and a man who was originally from Italy who claimed that he had been a volunteer in Banda Aceh, Indonesia and Sri Lanka as well. He stated that he had been helping there with the DNA analysis crew from Europe.

He appeared to have a good rapport with the child and his family and spoke several languages. However, Dr. Naiayana and I started to feel concerned when this man kept insisting that all this boy needed was to be allowed to run wild in the jungle " because he was a jungle boy" rather than stay in the hospital. Unfortunately, the child had relatives who suffered from schizophrenia and a positive genetic history made things a bit more complex. We wondered about childhood schizophrenia triggered by the disaster. Or a combination of PTSD and schizophrenia.

He was treated with Haldol to reduce his severe agitation and psychotic symptoms. He had EPS (extrapyramidal symptoms i.e. muscular rigidity, dyskinesia ) from the Haldol and Dr. Naiayana and I discussed his treatment plan to eventually reduce the Haldol very gradually to even as low as 0.5 mgs twice a day and 1 mg at night for maintenance. Or perhaps switch to Quetiapine but Dr. Naiayana found the atypical antipsychotics " too expensive". We still thought about Risperdone though, an atypical which was probably a good choice eventually for this boy. The boy had cogwheel rigidity but he was able to smile although hardly spoke. He was able to follow directions , walked slowly (bradykinesia) , but was coordinated. Sleep was still a problem.

And as we observed him, he appeared to be actively hallucinating, smiling inappropriately, staring in space, and very distracted. He was paranoid but not agitated. The Italian man kept talking to me about how the Thai now didn’t trust foreign volunteers for instilling "too much false hope " in them. And how many of the volunteers' services were not really needed.

One of the boy’s relatives eventually cut off this man and requested him to stop talking and distracting us so we could provide consultation for the boy. I reinforced the fact that Dr. Naiayana did the right thing in prescribing medications for him. I told them that I would have definitely prescribed an anti-psychotic medication for the boy. And that Dr. Naiayana would eventually taper down the medications to a maintenance level as he stabilized. And that we needed to give some medication that reduced the side-effects of Haldol. Artane. Low dose.

The family was appreciative of the consultation and gave their wais to us. The Italian volunteer and I also talked about how there were reports of children being stolen and sold to pornography and pedophile rings in Indonesia, Sri Lanka and Thailand. It was saddening to know that there were those who tended to capitalize on the misfortunes of others. He said that he was a chiropractor but could not practice his craft in Thailand so he ended up working as a Thai masseuse. Many of the hospitals there had a Thai massage center. This man also talked about how many volunteers were sent home by the Indonesian government because they got mad at them for trying to control things too much" . This was his story. Dr. Naiayana and I  reported him to the medical director to make sure that he didn’t interfere with that boy's treatment.

Before I decided to go to Thailand I was also thinking about going to Sri Lanka. However, a medical volunteer who went to Sri Lanka  told me about a volunteer from our city who went to Sri Lanka. A therapist. He had the full intention of volunteering his time for 3 months. In the first two days he was in Sri Lanka, some locals reportedly approached him and asked if he was an American as they needed help. They reported to him that their children were stolen. And supposedly the police may have been involved. The volunteer reportedly called the US embassy and also reported it to the UN who sent someone to track the kids down. However, the tracker never returned and something may have happened to him so the embassy tried to protect the volunteer from retaliative violence by instructing him to change his appearance by shaving his head and hiding out in the jungle for a couple of days until they flew him back home. This all supposedly happened in less than a week. I have no way to confirm the truth or untruth of this story.

We said our good-byes to the Phang-nga Hospital team for that day. Att , Sert and I drove down some curvy roads back to Khao-lak. But first we got some Thai massage. Really interesting. The place had several mats with pillows on the floor, curtains and fans. Att wanted a foot massage. Sert got his massage as well and I also did. We were all in the same big room so we were able to talk to one another and our masseurs. Thai massage. Hands, feet, elbows , knees are all utilized by the masseuse. Lots of stretching involved. 250 bahts for one hour. I think that it is great that Thai massage is very much integrated in health, healing and treatment in Thailand. After that we ate dinner. I felt better. I like the stretches. I love that watermelon juice - malakor. So refreshing. Back to the hotel. Tired. Showered. Journaled. Slept restfully.


March 29, 2005, Tuesday

TSUNAMI WARNING in Khao-lak, Phang-nga , Thailand

Midnight! Frantic knocks on my door - lots of rushing and urgent voice sounds and noises in the hallway. Initially I thought there was an emergency that required a physician. I abruptly got up, still in my light blue -green surgical scrubs, and opened my door. There were Att and Sert -- anxiously and hurriedly rushing to get their belongings-- Att cried out "tsunami -- in 20 minutes ! ". Their faces full of panic and fear. People were running up mountain. People alternated in halfway screaming out about the tsunami coming and silently dashing by us. I didn't even think. I just prayed silently, grabbed my handbag which had my passport and wallet and left everything else in the room.

After having met with the professionals in charge of the December tsunami resettlement and care the day before, I knew that we had to be 2 kilometers up- mountain to be reasonably safe from the tsunami. It quickly ran through my head that the probability of us dying was definitely there because no one can run that fast in that short period of time 2 kilometers up the mountain. Not even the Olympic runners. Surely not. The tsunami hitting again in the same area so soon. It made no sense. And yet it did. After all, the geological and meteorological  set-up was there now for tsunamis after the first one in December 26, 2004. I didn't know. I didn't know much of anything at that point.

The next 20 minutes. A tsunami. An unusually large seaware produced by an undersea volcanic eruption. A seismic sea wave. And in 20 minutes. Time. No time. This became the longest journey I've ever taken in my life. It was a journey from my head, to my heart and then to my soul.

As I was crying out for Sert and Att to hurry and leave all their belongings, I also started banging on the hotel doors that we passed by to make sure that other people were warned. Many times, during emergencies, people start going in circles from confusion and panic, and it truly is helpful to scream out and tell people to keep moving. Some feel and become immobilized from anxiety and fear. I started running as fast as I could encouraging Att and Sert to hurry up and leave their belongings. I had on thong slippers and was tying my surgical scrubs string belt as I ran, with my black bag on my right shoulder.

I had my passport in my bag. It felt like a horrible nightmare and yet strangely I felt a strange calm inside. I normally don't even yell and here I was yelling at some children and teens to keep moving as we went up towards the parking lot in the higher ground. I kept firmly screaming -- Go! Keep going ! Run! I guess that the physician in me took over and started giving out verbal orders thinking about their safety. At that point, Sert and Att became even more anxious because, they couldn't find the keys to their car and my heart about sank when I saw Sert go back to the hotel room to find the keys. Oh no!

"Come back here Sert!" We could just run up- mountain. We can't waste time.

The brave man went back to the hotel room to find the keys anyway feeling that it would save our lives for him to do that.

I just prayed really hard at that point. It was a relief to see him running up towards us and he rushed right into the car. Thank God.

Att and I started talking to Sert in a very calm voice to calm us all down. But because of naturally wanting to get out of there to save our lives, and being in such desperate hurry, Sert accidentally backed up and crashed onto a low concrete wall. My heart thumped pretty hard at this point.

Okay. Breathe. Staying peaceful in the eye of the storm.

Everything I learned about meditation , anxiety reduction, self-hypnotic focus on what we had to do, and every psychological defense mechanisms, all balled-up in one, went into effect automatically. The feeling of fight or flight. And we were fleeing from the tsunami and we were fighting time. That precious time.

That time that we normally waste doing unnecessary things routinely and which we take for granted.

The minutes felt like years. 20 minutes. No way. Yes way. Yes. We can do it. Yes we can. Just pray.

Att and I tried to calm down Sert so he was able to drive. It was an inordinate amount of pressure on him. Watching him put the keys in the ignition felt like years. He must have felt like our lives were in his hands. Att and I kept saying that it would be alright.

And in a way it really felt like that. Bless his heart. Good man. And Att. What a lovely heart of a lady. I thought that if I died then, that I felt blessed being in the company of this very kind and tender couple. They had been so protective of me in every way that I felt at home anywhere we went.

Other cars were going chaotically up the mountain. Some almost bumping onto one another and beeping their horns. This was when my life truly flashed before my eyes like a film. First a fast rewind and then an intense fast forward. I felt all the sorrows and joys I've ever had since I was a child in a very compressed manner. Very very compressed. People I've loved and who loved me flashed into my senses and vignettes of feelings of love and comfort prevailed.

All of a sudden there was clarity in my heart. Peaceful. A sense that all was forgiven. The wrongs I have done. The wrongs that were done to me.  A sense of being able to look back at my own actions both good and those I was not proud of. It was as if I was given a chance to see my own soul from a divine perspective and still be grateful for my life and the people who have been there for me. The erasure of the record of any wrongs ever done by anyone. Corinthians. Patience. Kindness. Compassion. Faith. Hope. And most of all , Love.

I thought about one of my esteemed mentors Dr. Wayne Oates. In asking him so many questions about how to integrate some of the Biblical passages, he gently and wisely said to me. " Liz, when confused, just keep it simple. Just focus on the 2 main commandments - Love God and love others." Brilliant sage. So after that, every time I reflect upon my actions I worked hard in discerning whether what I do or the decisions I make manifest the 2 most important spiritual mandates. Many times I fall short. Way short. But I still get back on the horse and just allow myself to follow those spiritual anchors. I believe that all of us are God's children, no matter what religion.

I thought about my children, family and friends. I thought how incredibly blessed I was to have a family like mine. All so incredible, brilliant and loving in their own ways. My dad. I wouldn't trade him for any dad in the world. He would have known what to do in a situation like this as he and my uncles have consistently done medical missions in remote areas in the Philippines. Big-hearted, generous, an excellent leader, very intelligent and would do anything for the family, friends and for those who need his help. My mom whose illness has served as an inspiration for me to pursue my goals in life and who imparted her love for piano and music to my sibs and me. My stepmoms. Such family-oriented ladies. Both so lovely. I thank God for their presence in our lives. My sibs. How I love my siblings. They are all so talented and loving and we are all so bonded even more so after Alex's tragedy. My little nieces and nephews. They are so delightful and have given me joy. And my cousins. How I love them. Who are truly like my sibs as we grew up together in the Philippines. And all my uncles and aunts who helped raise us all and imparted their talents and best love to us.

I thought about all my friends. My elementary and high school Prepian friends. They have given me much heart's delight and a spirit of eternal youth. So much laughter and unconditional love. My many friends at work who were there for me during crucial times in my life and who enjoyed my joys. How can I not feel grateful and blessed?

My work. Our work mission to help those who are suffering mental illness, chemical dependency and developmental disabilities. My colleagues and friends, and those who spent most of their lives in the service of others. My patients. Their courage to slay their own dragons. Their strength in dealing with the sorrows and pains in their lives. I thanked them in my mind for allowing me to serve them in some little way, and in having done so, I felt served in my heart.

I thought about my relationships and the fact that I was letting go. And briefly wondered if letting go was truly the way to go in love. And my search to learn and feel the unconditionality of love even more now than ever. And the ability to concentrate on loving rather than being loved. Since my divorce in 1997, I've withheld myself from loving to the max. And I need to know the meaning of loving like I've never been hurt before in this lifetime. The divorce was generally amicable and my ex-husband will always be family to me as he is the father of our children. He also went to Sri Lanka to help out with a tsunami medical mission with the Rotary Club out there. I loved my parents-in-law who are now deceased. They were just like my paternal grandparents who I absolutely adored. They all four raised the bar for role-modeling what love for a spouse and family should be.

But most of all, I thought about my children and prayed for God to keep them in the palm of His hands and surround them with his Light and love whether God decided to take me then or not. I thought about Alex . My son who gave me much joy. Very bright, sociable, multi-talented, and how now he was in a place where he can pray for us all. And how he is starting to see his own light in the midst of darkness and illness. And that my prayer that he can feel and give love again . A miracle in itself. The prayer that we could be there to hug those who were affected by his illness and console them and feel the healing in all our hearts. Miracles. I expect them now. And Jackie. My old-soul, loveable, beautiful, intelligent, compassionate, philosophical daughter. She is a spiritual trudger. And has profound insights for a young lady her age. She has given me courage to face all that I had to face and the thought of her helps strengthen my faith. Academically on track and doing great. But even more, her heart is on track. I thanked God for my children and to be allowed the privilege of being their mother.

My priorities started to take on a more orderly perspective. Peace in the eye of a storm. I started to be clear about what really was important in my life. It was not prestige, career, material things, pride, places, self-will, fame, fortune. I felt a freedom in detaching from things in those few moments. And realized the meaning of attaching myself to what counted. Love.

It permitted me to experience the meaning of what the Native Americans said about Love being the only thing that is real and all else just an illusion. It sorted out the meaning of applying all these to the relationships I have and what was truly significant in a relationship. It was a realization that love could rise above all pain, angst, hurts, pride and self-centeredness. And what counted was loving someone and wishing them their highest good, no matter what. And that love has to do with giving ourselves and a beloved the chance to clean slate and forgive all past wrongdoings on a day by day basis. And that the miracle inherent in faith and within the context of love supercedes all human frailties.

It allowed me to want to take a genuine risk, if I miraculously survived the tsunami, to love the best I could applying spiritual principles. And that I knew what I had to do if I ever came home alive. Loving does involve great risks. It also involves letting go of fear. And it involves a heartfelt commitment no different from the faithfulness and belief I have in God. I realize that it may never be the same. But that feels alright. For I now understand the meaning of slaying my old self even more to give birth to my spiritual soul. I opened my heart to love with a renewed courage and with faith. I need to go where love is. And I see it now.

Sert, Att and I parked on one side of the curvy street that hugged the mountain. There were cars, vans and pick-ups on one side of the street. And the people were all lined up on the other side of the street where there was a low concrete wall where we can overlook the Andaman Sea beaches. Some of the kids were huddled around slumped down with their backs to the low white concrete wall. Some were looking at the waves coming in from the sea. A group of Christian missionaries formed a circle and prayed . People were wearing their pajamas and some were half-clad. There were many teen-agers and children talking closely to one another. Some Buddhist Thai adults were silently meditating and were sitting down on the ground. One could feel the anticipatory tension in the beginning. Some of the teens were laughing, anxiously helping each other minimize the idea of a potentially pending disaster. People started frantically clinging on to their cellphones calling their families. Someone then requested for us not to use the cellphones because it was clogging up the telecommunications system and we were needing to be able to communicate if the tsunami hit. How I wished I had my ham radio there.

Someone started to increase the volume of their radio and we had some Thai pop music on. It actually helped. But then, I requested Sert to ask someone to turn on the radio to the news so we knew our situation from the outside world perspective. That would help us deal with what we had to do if the tsunami did hit.

The news reported that there was an earthquake in Sumatra, Indonesia - similar to when the December 2004 tsunami occurred. Att called her daughter and I requested for her to please tell her daughter to call or e-mail Bruce Houser, my initial in-Thailand coordinator, who was in El Paso Texas with his wife and son at that time, so he could call my sister Marissa to let my family know that I was alright. We had to go against the protocol of no cellphone use after we heard that the news already hit CNN. And we didn't want my family to be in limbo worrying about me out there.

I spoke with some of the American Christian missionaries. One pastor's wife was there with her baby. A young blonde -haired lady who appeared exhausted from the situation wearing a pajama bottom and white t-shirt. It was fascinating to hear an American speak in colloquial Thai so well . She told me that they were in a 4-day music ministry with the teens they were with, and they normally lived in Bangkok. Her husband, who grew up with missionary parents in Bangkok was also very fluent in Thai. They came back to live in Bangkok for 4 years now and she was very much in tune with the nuances of the Thai culture which was great to know. I spoke with a couple of kids and teens who were somewhat anxious. People started taking photos and so did Sert.

Twenty minutes have passed and no tsunami. We were much calmer. People started to smile again and laugh a bit more. Less anxiously. Att and I talked about a Plan B. Perhaps move to a different hotel higher up in the mountains. People told us to wait until 3 AM before we went back to our hotels. Att and I thought that it would be safer to wait even a bit longer. The news reported that Banda Aceh, Indonesia was being evacuated. And we were more relieved when the news reported that the waves were headed South away from Thailand.

Thank goodness. Big sighs of relief from all. The " bahala na " Filipino attitude helped. Whatever it is and will be, God will take care of it and that God knew what He was doing. Let go and let God. Many cultures who have been ravaged by disasters and wars end up having this spiritual surrender attitude to deal with the overwhelming atrocities of war and the trauma of disasters.

It was time to go back to the hotel. I cherished the relieved smiles of the teenagers and kids. There were teens and young adults scootering and motorcycling everywhere. For indeed it would have been much safer to be in one of those since they quickly and more easily maneuvered more than cars all around the zigzag mountain streets. We were all exhausted but obviously grateful that the tsunami did not wipe us out. The air-con in the room felt great. Wonderful soft white sheets. And soft pillows. I marveled at the woodwork all around the room. I prayed with much gratitude in my heart. Prayers for my family and friends. And wished the people I loved, the ones who loved me and the ones who may not even care about me, and the rest of the world peace and happiness. I will try to find an internet cafe tomorrow to communicate with my family and friends to allay their worries. Especially my Jackie and Alex.


Still March 29, 2005, Tuesday

The morning after the tsunami warning

I actually rested and slept for a few hours after we got back to the hotel. Tired but full of spiritual thoughts. I also thought about how we were warned about the tsunami at 12 midnight and the other volunteers we met said that their hotels were warned at 11 PM. I was just glad that we were all still alive and breathing. And thankful for the fact that we were even warned. And that the tsunami somehow veered off away from Thailand. It showed how important warning systems really were.

The few hours of sleep must have been so deep that it seemed enough. I had no clue how I was able to sleep that deeply that night. I must have just crashed from pure exhaustion. I think perhaps thinking about serving more patients give many of the medical volunteers more stamina to give out there no matter what the circumstances. I dressed up and went to the hotel terrace for some breakfast. Fried rice, egg, watermelon and pineapples. This time I was up before Sert and Att.

We drove through the zigzag winding roads all the way to Phang-nga Hospital. It reminded me of the zigzag roads to Baguio City in the Philippines. Baguio is a wonderful resort area in the mountains and the weather there seems eternally temperate and cool. My family and I spent many memorable times there during the summers visiting my aunt, a Mathematics college professor at age 19. The mountain we passed literally felt like it was hugging and cradling the main road within its bosom. We finally got to Phang-nga Hospital and Dr. Naiayana was already seeing patients. We waited briefly in the conference room. She wanted me to first meet their hospital medical director Dr. Sam-ian. Dr. Sam-ian was such a gentle , soft-spoken, kindly man who was warm , receptive and very accommodating. He seemed to be well-loved in the hospital and his staff practically tripped over to happily greet him with their respectful wais and smiles.

We talked for a few minutes and he asked what he could do for us. I told him about GSC in half-Thai, half English. And about my desire to volunteer in some way for the tsunami affected families and children and to network with other Thai psychiatrists for mutual teaching and training, cultural exchange, and mutual interchange of effective treatment ideas. And how I can serve them as a child psychiatric consultant while I was there. They did not have any child psychiatrists there and most of the children were cared for by the pediatricians . The more severely emotionally troubled children and adolescents were seen by default by the adult psychiatrists. Dr. Naiayana expressed her positive feelings about having a child psychiatric consultant there and already thought about patients of hers who were children and how she needed consultations regarding their problems.

Dr. Sam-ian spoke English fairly well and said that he was in the USA once and mentioned St. Louis. Att and Sert brought some goodies from Kanchanaburi to give to Dr. Sam-ian and Dr. Naiayana to let them know that they were appreciated for their collaboration with us. Dr. Sam-ian also made sure that I had something from Phang-nga -- little round bread-like cookies with sweets inside. We have something quite similar to them in the Philippines - we called them " hop-ia". How thoughtful.

Dr. Naiayana and I saw several patients that morning. Back to back and seamlessly. The nurses were quite efficient and helpful.

Dr. Sam-ian and Dr. Naiayana (pronounced Nah-yuh-nah) walked us through inside the hospital and made time to show us the hospital grounds. He was especially proud of the hospital's new Thai Massage Center and asked me whether I wanted a Thai therapeutic massage done. They have integrated Thai massage for therapeutic purposes there as part of their holistic treatment. I spoke with Dr. Naiayana about one of the patients we saw that morning who was suffering from myalgias. She was on an antidepressant and Valium and we talked about her need for the psychiatric nurse to follow-up on the patient for psychotherapy. This lady also had a post-menopausal syndrome and we discussed more about holistic medicine. She was on an estrogen patch as well. She may well be a good candidate for the Thai massage and she thought that it was a good idea.

There was another patient -- a Moslem lady who was wearing her religious weil. Islam is a minority religion in a predominantly Buddhist Thailand. She was very expressive, open and verbal. And she expressed her fears about the potential teratogenic effects of Anafranil and Valium. Dr. Naiayana tried to reduce her medications because we found out that the lady was 3 months pregnant. She expressed her anger at the previous psychiatrist because she felt that the medication made her previous child mentally retarded. Now she was afraid that she might have another child with mental retardation while on the medications. At the same token , she also felt fearful that the agitated anxiety she had because of symptoms of PTSD from the tsunami would re-surface. She lost several relatives in the tsunami.

We talked about the risk-benefit ratio of being on medications versus off. Dr. Naiayana translated the questions for me and asked me what I would do for this lady if she were my patient. I recommended an OB-GYNE consult, very gradual reduction of medications especially the Valium to prevent withdrawals. I told her that in terms of benzodiazepines, we tend to  prescribe Klonopin more in the USA if there was a need for an anxiolytic as it was easier to withdraw than Valium and Xanax. The withdrawal is smoother. We advised the patient that the best for the baby was no medications except for pre-natal vitamins. She was another lady who could benefit from a psychiatric nurse therapy.   Since they lack psychiatrists, the psychiatric nurses ended up with most of the follow-up therapies as their psychiatrists virtually had no time.

We also saw a 7 year old boy who had a history of rape by older boys and who lived with his grandmother. His mother had abandoned him. Separation anxiety Post-traumatic Stress Disorder and ADHD symptoms. Some depression. Some relatives who died from the tsunami. He was on Tofrani (Imipramine ) as he was also enuretic. We discussed lowering the dosage a little and spreading the doses more evenly throughout the day. The child was having some breakthrough acting-out during the day. He was also having some nausea at times.

There was a man diagnosed to have " Body dysmorphic syndrome". He saw his face as something different in the mirror and could not look at his own eyes. I wondered also about major depression with paranoid symptoms. He was on Haldol. Some psychotic symptoms start out as the feeling that their bodies are morphing into something else. Almost like Kafka's Metamorphosis. Sometimes the symptoms are quite subtle that it becomes difficult to prevent the frank decompensations. He had people he knew affected by the tsunami.

Another gentleman over 60, was treated with Fluoxetine. He had depressive facies, with the downturned mouth and sullen saddened look, but overall had been improving according to Dr Naiayana. He appreciated his family support. He also had friends affected by the tsunami. The patients were all generally respectful and soft-spoken with the doctors. They were mindful of the psychiatrist's time and knew that their session would be brief. They try to get right to the core of the problem and Dr. Naiayana maintained her gentle attentiveness and reflective listening throughout the clinics.

Dr. Naiayana, Dr. Sam-ian and I all went to a special room for lunch. We had time to compare notes about medicine in general in the USA and in Thailand. We talked about their need for more psychiatrists. We had fried rice, egg and soup for lunch and refreshing cold water. It was truly hot that day. Again all of us were sweating. I thanked them both for allowing me to visit their hospital to see patients. They have been more than gracious. We also talked about how we needed to make sure that we set some therapeutic boundaries with the volunteer we met yesterday who was somewhat interruptive of one of the children's care. The medical director listened to the reports and knew who we were talking about. We three doctors agreed that we needed to be aware of this man's desire to help out but also to be aware enough to set limits with him when it came to the care of the patients.

Dr. Naiayana showed me to the doctor's lounge where I was introduced to several friendly, smiling doctors who teased each other as old friends would. Multi-specialties. In the back call room was a computer and they were kind enough to allow me to use it so I could e-mail my family and to let them know that I was okay there. I caught up with Dr. Naiayana for the afternoon patients. We went to re-visit the boy who had psychotic symptoms from the tsunami. The boy was with his extended family and this time without the volunteer. He was talking much more and smiling more. No more cogwheeling nor muscle rigidity. Great! The Artane was doing its work to lessen the extra-pyramidal symptoms from Haldol which caused the child's muscles to be stiff and very rigid. However he still had some nightmares about the tsunami. He was able to talk about how he had hallucinations of goats and monsters coming at him and trying to attack him. He was definitely more improved on Haldol and Artane. The extended family felt comfortable with his care but proposed to also have the boy go home for voodoo. I was initially hesitant until Dr. Naiayana said that it was their custom to respect the beliefs of the people and integrate them in their treatment. A wise custom, I thought inside. Dr. Naiayana and I agreed and also discussed a time limitation and that the child needed to be back for medication stabilization and adjustment as needed. We agreed on 2 days and then the family agreed to bring the child back for more care. Treatment collaboration in action.

We then walked into the women's ward. There was a young lady with schizophrenia on decanoate medications. She was stiff, rigid, had problems articulating, dry- skinned, and very slowed down. There was another lady with depression, anxiety and panic attacks. She needed much reassurance and wouldn't let go of Dr. Naiayana. Supportive therapy done with a smidgeon of Cognitive Behavioral Therapy. Aaron Beck's CBT .

It was time to go. A long yet very rewarding day. I really enjoyed the time with the hospital staff. I exchanged e-mails with some of them and I invited them to visit Kentucky if they ever visit the USA. There is nothing like knowing someone when you visit a different country. We gave each other our sawatdee khas and wais.

The drive back to Khao-lak was scenic. Again the curvy roads hugging the mountain (and the mountain hugging them back) were starting to get to my queasy stomach so I relaxed in the back of the car, meditated and consequently rested and slept a little bit. I thought about Phang-nga Hospital settled against a Bali-Hai type mountain setting. And about such a bright, poised personable psychiatrist with so much responsibilities for her young age   and training whose only desire was to get married and have her children someday soon. A young lady who openly talked about her first true love - a confidential disclosure between psychiatrist to psychiatrist. I enjoyed her loveable humanity even more and thought that they are fortunate to have her there.

We took more photos of the Khao-lak beachline. During that time, many policemen were guarding the highway because the king's nephew had arrived there. The Thai truly love their king and the rest of the royal family. Back to the hotel for rest. Journaled some more. Napped.

A knock on the door. Att. She excitedly said that the sunset was beautiful. Photos. Beautiful sunset indeed. We watched and took photos of the sunset until the sun went completely down on the beach.

I thought of the song " Don't let the sun catch you crying..the night's the time for all your tears. Your heart may be broken tonight. But tomorrow in the morning light. Don't let the sun catch you crying."

 An old song. Brings back happy memories in spite of the maudlin nostalgia of the song. Innocent times in high school. And to think that all those high school friends of mine, the Prepians, are still dear friends of mine even now. We all found one another again thanks to the internet. We always have reunions everywhere in the world. And we all regress like children again. The gut-hurting unstoppable laughter when we are together. A timeless fountain of youth just by being together. All because we were randomly schooled in an awesome experimental high school where most of the teachers had their doctorates or masters level education. Most of the students had plus or minus 10 - IQ level. We all had to take a national entrance exam to get in. Did it make a difference in our education? We all think so. We still honor our teachers even now.

The Khao-lak sunset that day. Pinks, light orange, lavender. Blue waters. Utterly peaceful. We prayed for those who died in the tsunami again. Peaceful. Calmness within.

We drove to the same restaurant that night. The Jai Bungalow restaurant on the main strip. It was like a hut-- decorated with white lights. Tourists were starting to come but since the tsunami warning, many cancelled their trips. The locals were disappointed. That dinner was interesting. Sert, Att and I had more of a chance to talk about them and found out that Sert was also a ham radio operator! I was licensed Extra Class when I passed the exams in February , 2004 and my call sign is N1VZ. November - One - Victor - Zulu. In 9-11 and in disaster times, the ham radios have been very helpful in terms of creating more seamless communications. There are times when even the cellphones do not work nor do the computers nor landline phones. That's where the ham radio operators come in. I had no initial knowledge about electronics except that I found Physics interesting. And that helped me pass the amateur radio exams besides studying so hard for them.

The hams are great. They are very helpful. There was a story about a lady from India who was on a DX-pedition ( DX- distant station ) with her team and the tsunami hit in one of the islands off the coast of India. She ended up anchoring and helping the communications of the island with the mainland during those turbulent initial tsunami times. I like our ham radio saying " When all else fails... there's ham radio." My sense of world geography has expanded since becoming a ham. I also wanted to make sure that when I am doing global medical missions in remote places with barebones or no communications, that I could use the ham radio to help and get help somehow.

Back to Sert. He said that he served in the Vietnam war and actually volunteered. He served along with Filipinos, Americans, Koreans and Australians and he drove army trucks for them. Sert was in training for 6 months and then was in Vietnam for one year. He learned to use the ham radio there. We talked about the veracity of King Bhoumipol being a ham radio operator. Was it really true? Many say yes. And was his call sign really CHO? We talked about our ICOM ham radio rigs and about my dipole antenna. Att said that Sert used to CQ every night. I encouraged him to get his license again so we can do HF - high frequency - contact.

He said he would. Small world. I slept well that night. I felt happy inside. Absorbing and embracing pockets of small joys in this life. And remembering the feeling.


April 1, 2005, Return to Bangkok

" To affirm life is to deepen,

to make more inward,

And to exalt the will to live. "

~ Albert Schweitzer

Rest morning. I just slept. Contemplated. Meditated. Took it easy. I moved slowly about the room and read the Thailand Guide. I saw that they prided in Thailand as the health tourism hub of Asia. Plastic surgeries, for instance, which cost a lot in the USA. The prices in Thailand are half the price for most procedures. People like to go there because not only do they get their inexpensive surgeries, but also they get an exotic trip and a vacation out of it, for the price they would've paid in the USA.

Just some random reflections:

* Koh James Bond - ( Koh Phing Kan in Thai ) - where The Man With the Golden Gun was filmed. Right where I was. In Phang-nga.

* King Bhoumibol Adulyadej ( King Rama IX of the Chakri Dynasty ) born in 1927 in Cambridge, Massachusetts. His father studied medicine in Harvard. He has reigned over 50 years and has done many public works projects with a focus on the underprivileged. The king and the queen have 3 children. Most royalties should be like them. For their people.

* Thinking back to the day after the tsunami warning. And how things were quite peaceful the next day as if nothing really happened. What was past was past. And all the volunteers went back to work and the locals resumed their jobs calmly. Amazing spirits. People's abilities to suppress traumatic experiences and extract the good from it. And then the ability of people to move on and live in the Now.

3:15 PM on the dot. It was one my friend's friend. I went down to the lobby and somehow missed her. When I came back I saw a very petite slender, smiling Thai young woman in her thirties. Her English was fluent because she went to Murray College in Kentucky. It felt good to meet someone who spoke English fluently and knew Kentucky. Instant rapport. She knew my friend from his shipping business in Chicago. We took a cab to River City mall next to the Royal Orchid Hotel for my fitting for the bluish-purple gown I bought made out of Thai silk. They did a great job and were supposed to deliver the gown to the hotel. I have an appreciation for how Thai silk is made. We walked around the air-conditioned mall. Hardly any tourists or people there. More high-end stuff. A bit expensive. Many Asian antiques. We just window-shopped and talked about life experiences she had in the USA.

We then went back to the hotel to meet another friend. There I met another very polite and personable young lady. Both were contacted by our mutual friend from Chicago also named Lek. Both ladies were quite open about their lives. Even their love lives. They each found out that they just broke up with serious relationships. We irreverently laughed about all that and talked about how they both met my friend Chicago Lek. So now there are three Lek's in this journal. Dr. Kung's husband Lek, GSC Lek and my friend Chicago Lek. Just to set the record straight. We all laughed a lot together. Like three sisters would.

We met another friend and his pregnant wife at the Tapli-pling Restaurant. More seafood. More fish. We all talked about life, jobs, hopes, relationships and the tsunami mission. They were all warm and friendly and more Westernized. One of them used to be a pharmaceutical rep in the US and I requested for her to please check some drug companies in Bangkok to help aid the camp settlement babies in Khao-lak with some powdered milk. She said that she would get on the ball with that immediately.

We had coconut ice cream for dessert. They said they wanted to walk around. They all decided to check out the Hindu temple. They were all Buddhists. Curiosity. So we did. The temple was very busy inside. The Hindu pagoda was so colorful. Some people were meditating, some lighting candles, some doing flower and fruit offerings. Incense everywhere. We all took off our shoes and visited the temple. More religious and cultural immersion.

Then we drove to the Suan-lum Night Bazaar. I liked the ambience there. Night lanterns and all on the streets and restaurant-cafes. Lots and lots of shopping. Too overwhelming. The stores were well-displayed and organized. I found some beautiful shawls and Thai silk ties to bring home as gifts to family and friends.

What a wonderful way to end this journey. Having a relaxing easy time with friends of a friend. That was nice of Chicago Lek to have arranged this to end my trip. He actually called us all when we were in the restaurant. So we all had fun with that. One of the girls kindly picked me up at the hotel at 4 AM and drove me to the airport. What an inconvenient time for her but she was so gracious and sweet about it. Very nice young lady.

I was finally all packed. It has been a trip beyond my imagination. I will forever be grateful for this experience. I will not forget the many good people I've met here and all the wonderful GSC staff who worked with me to sate my soul in the desire to serve others. I thought about the children and families affected by the tsunami, the medical and nursing team, the public health crew and the many volunteers from all over the world. One world united by compassion because of a disaster.

My cup runneth over and my spirit felt full. I learned a lot and taught some. I thank God for allowing me to experience all these in this lifetime and for reaffirming the thought that in this life, in this world, there is one thing that truly counts above all. For when it is all said and done, all that really matters at the end of our lives, is how much we have loved.

"When all is said and done,

And the dust has settled in

I ask myself,

Did I feel all the Love I was given?

Did I give Life my optimum?

Did I Love all my maximum?

~ Elizabeth A. Garcia-Gray MD



a 501(c)3Corporation

4509 R T Cassidy Drive  El Paso, TX  79924

Phone: 915-755-3181 Fax: 915-755-3181 E-mail:

May 30, 2006


The purpose of this letter is to support the nomination of Dr. Elizabeth Garcia Gray for the American Psychiatric Association Distinguished Fellowship.

My name is Bruce Houser and I am President of Thailand Service Corps (TSC).  TSC is a non-profit 501 (c) 3 organization which provides service and learning opportunities of volunteer participants in Thailand. In February 2005 I was contacted via the internet by Dr. Elizabeth Garcia Gray.   She was interested in a volunteer mission but only had a window of two weeks due to a demanding professional schedule.  Thailand was still in after shock from the Tsunami in December of 2004.  As I read in the press and spoke with local medical professionals, I knew there was a great need of Psychiatric help for children and families affected by the Tsunami.

I designed a project for Dr. Gray that first placed her at a hospital in Kanchanburi Province, to work along side a Thai psychiatrist.  This enabled her to gain an understanding of Thai people, Thai medical professionals and the medical system.  The second part of her project was to help medical professionals, families and children in Phang-nga Province, the most Tsunami devastated area in Thailand.  My in-country staff provided coordination with the Thais, transportation, accommodations, logistics and translation as needed during her project.

Dr. Garcia-Gray became a mentor, counselor and coach to the Thai medical staff, and those families and children victims of the Tsunami devastation.  The Thai medical staff had a single Psychiatrist.  Dr. Garcia- Gray used her specialized training and knowledge to advise Thai medical personnel on proper diagnosis, the use and types of therapy and medication use.  She not only visited, aided and assisted the hospitals and medical staff but went to the remote field camps set up by the Thai government to house the Tsunami victims.  Accompanied by my staff and Thai medical personnel, she coached the Thai staff in diagnosis and treatment for many children and individuals residing in the camps.  She gave of herself and her time in this truly humanitarian endeavor for the good of mankind.

I am very pleased to recommend Dr Garcia-Gray for the American Psychiatric Association Fellowship.  She made a difference in the lives of many Thai medical professionals, doctors, families, and the children that she met.


Bruce Houser


Thailand Service Corps












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