Day of Reckoning

This is it: the result of four years of formal medical education all hinges on our performance in three hours this afternoon. The sixty or so of us taking the exam this afternoon get to the hospital and wait around the lobby to be called in. We are then herded into another room, wait some more. The room is humming with anxiety; some of us chit chat to distract ourselves while others flip through pages of notes. Psychogenic diuresis kicks in, we drink more water; the toilet is in constant demand. After an eternity, we are lead out of the holding room to our respective stations. At the sound of a buzzer, the exam is officially started.

Three hours later, the last buzzer is accompanied by a collective sigh of relieve from all of us. We stream out of the hospital, some recounting the points they failed to make, some swearing they will be blind drunk tonight. I am just happy the whole thing is over.

In the evening, I join my fellow classmates at the Royal Exchange Hotel, the local watering hole frequented by college students, for a night of celebrating the end of medical school and, for many people, to say good-bye to each other. Soon enough, we will all head our separate ways.

We greet each other by a hearty “Congratulations, Dr. [insert last name]!” and point out the novelty of being called doctors. When used in front of my name, it still sounds so oddly formal. With beers in hand and over the amped up guitars by a cover band, we talk about where we will be next year, what specialties we want to go into, and the possibilities the future might bring. The buzz goes late into the night.

We have done it! I have done it! It feels surreal – to not being a student anymore, to not having to worry about studying tomorrow, to finally have a job again.

One Day More...

Until this is all over! The big, end-of-medical-school-and-must-pass-to-graduate exam is spread out over today and tomorrow. Our class is split into four groups: Saturday morning, Saturday afternoon, Sunday morning, and Sunday afternoon. As always in this kind of situation, I have the misfortune of being allocated to the Sunday afternoon session, just to ensure that the agony of endless waiting is prolonged. The exam is the live, face-to-face type consisting of nine live stations in which we are given scenarios and are instructed to talk to or examine or device a management plan for the real or volunteer “fake” patients.

By now, half of the class has already finished their exams. I am sure they are all appropriately in an altered mental state, but continue to quaff large quantities of alcohol in various disguises which, for many, has been the one constant through the four years of medical school.

While those half of the class are blowing off steam and generally engaging in wanton revelry in ways that may potentially be career-enders should they wish to enter politics later in life, this half – well, me at least – is trying to use our psychic power to predict the questions and topics that will be on our exam tomorrow. They had a cardiovascular system examination station today? I think it might be respiratory or gastrointestinal system tomorrow. They had an O&G station consisting of contraception advice and placenta previa today? It could be pre-conception counseling and pre-term labor tomorrow. Today’s ophthalmology station had patients with glaucoma and retinitis pigmentosa? We’ll probably get a couple of patients with macula degeneration and diabetic retinopathy…

No more studying. I am as ready as I will ever get. It’s time for some sleep.

Turkey of a Day

Happy thanksgiving! Hope your turkey is delicious.

Because I’m not having any.

I’m getting used to doing nothing for Thanksgiving now. For one thing, in Australia, today is just the fourth Thursday of November and nothing more. Secondly, we have our big, end-of-medical-school-and-must-pass-to-graduate exam this coming weekend. Any holiday would have to take a back seat to studying. For the last few days, I have set up shop in the library with my study group, pounding the past exams. And today was no exception.

So I came back in the evening, cooked up some quick pasta, and called it a day.

Maybe I can do some kind of Thanksgiving dinner next year.

Ten for Ten

In the early afternoon, I walk out of the children’s hospital with the other student in the rotation, feeling tired but relieved. Now that the exam for pediatrics is behind us, what are we going to do?

First, a beer is essential. Then, I am just going to enjoy the sunny afternoon.

Next week is study week for the big exam: everything we have learned over the last four years will be fair game. The diploma is going to be hinged on whether we pass this exam. So, the pressure is on.

But for this afternoon, I’m not going to think about it. Maybe I’ll even go see that new Bond movie tonight.

All Studies and No Exercise

Ugh, I feel like my body is atrophying. This is the last week of the rotation, which means serious study time, which is encroaching on my exercise time. For a whole week now, the only exercise I have been getting is my bicycle commute to and from the hospital. At a measly seven kilometers roundtrip, the commute is long enough to make me break a sweat, but not long enough to make me feel like I got a workout from it. Well, it’s better that than nothing.

Halelujah

I guess I can say "Halelujah!" that it's almost the end of medical school. But this halelujah actually refers to one of my extracurricular activities - the Queensland Choir. We are singing Handel's Messiah this year and this is the final week of rehearsals. Last week, with my unlucky viral infection, my voice dropped an octave and I could only sing about two notes. Singing then would probably get me kicked out of the choir. So, with my voice recovering over the weekend, I feel like I should join the last two rehearsals before our concert at City Hall this coming Saturday.

This will be my final performance with the Queensland Choir. The Messiah is always fun to perform. It was one of the first concerts I had performed in during my undergraduate years with University Singers. In the following ten years or so, I had performed it with other groups a few times. The complexity and intricacy of the masterpiece makes it a challenge but also a joy to perform each time. And each time I gain a new appreciation for Handel's genius.

After this concert, the choir will break for the summer and next year, I will be far away from Brisbane. During the three years that I had been able to sing with the Choir, I had a lot of fun learning new music and making new friends. With no formal music education and not able to play any instrument, I can count on singing as the artistic complement to the scientific side of my life. Being able to sing with a dedicated group of enthusiastic singers and lose myself in the music is incredibly stress-relieving, even during rehearsals when we get yelled at by the conductor.

Halelujah!

Downed by Germy Kids

Everyone else on the pediatric rotation has been getting sick. It seems that whatever virus the sick kids have been coming into hospital with, it is now being passed around our group of med students. A few of my compatriots have already been feeling miserable as of late. Amidst the constant sniffling, I have luckily avoided getting hit - until last weekend. A hint of a sore throat on Friday brewed over the weekend and, by today, has become a full-blown case of viral upper respiratory tract infection. This has got to be the worst time to be sick. There are only two weeks until the end-of-rotation exam and then another week until the final exam. I really can't afford to be sick this close to two important exams. I know it's probably viral and I just have to let it run its course. If it's caused by what the kids have been spreading around, I should be feeling pretty sick these couple of days but I will be fine come exam time. Let's hope it's that and nothing worse.

A Historic Day

After lunch, I am on my way to the ward to find more information from a patient's chart for my case presentation when I decide to stop by the staff tea room for a cup of coffee. As I enter the room, I hear the TV on with sound at full volume. A couple of nurses are organizing charts while looking up occasionally at the TV. The local TV channel is carrying live coverage of the US election. I make my cup of coffee and see Barack Obama on the screen getting ready for a speech. At the bottom of the screen flashes the designation: "President-Elect." As he starts to speak, I sit down with apt attention and sip my coffee absentmindedly.

Earlier in the day, I looked up the election returns online whenever I could. As I watched one swing state after another going to Obama, first Pennsylvania, then Ohio, then Virginia and Florida were starting to look more and more blue, I became increasingly hopeful even though the results were only based on exit polls. It almost sounded too good to be true - what, no "too close to call", no outcries for recount? I wasn't going to get my hopes too high; I was almost anticipating that some of the swing states would turn yellow, and then we'd get bogged down in yet another round of law suits for recounts and countersuits to stop recounts. I was telling myself that I wouldn't be convinced until the official counts were confirmed. Now that McCain has made his congratulatory phone call to Obama, I am relieved that the drama that had followed the last two elections won't be repeated this time.

I watch as President-Elect Obama speaks in his trademark soaring oratorical style. I notice that my eyes grow moist as his infectiously hopeful speech goes on, his eloquence a stark contrast to what we have had to suffer through in the last eight years. Images of his elated supporters crying, singing, and celebrating flash on the screen. Obama's election has brought hope to me and to many people who feel the country is heading in the wrong direction. But this is only the beginning; we can't expect Obama to fix everything. The things that are going wrong in the US are beyond what any one person can do to fix. He is inheriting a country with its economy in the dumps, a health care system already running over the cliff, and the only thing constantly going up is the national debt. These problems won't be solved overnight, but I know the one thing Obama can do as soon as he takes office is to repair the United States' image internationally. To paraphrase a popular credit card commercial - one economic bailout package: $700 billion; fix the health care system: $50 gajillion, to have the United States regarded around the world as the beacon of freedom and democracy once again: priceless.

With Obama's speech over and the local station switching back to its regularly programming, I dab my eyes dry and start my way to the ward again. I walk out of the staff tea room with a slight spring to my steps; I, as an American, am standing taller today.

Burning Out

There is a recent article on the New York Times about medical students in the US feeling burned out and depressed that contains some alarming statistics: 11% of those surveyed have had suicidal thoughts from depression, almost half of medical students surveyed suffered from emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Among the factors cited are the constant lack of sleep, the pressure to excel, the hazing from senior students and residents, and having the firehose of information aimed at them non-stop. In the article, the author, an accomplished specialist herself, recounts her years in medical school when she felt miserable but unwilling to admit it because she did not want to admit to failure amidst the fierce competition among her fellow students. The article paints a picture of cut-throat competition and every-man-for-himself mentality in the US medical community.

After reading that article, I feel especially fortunate that I had decided to go to medical school in Australia. Now in the final month of medical school, I can say that I have not had any reason to feel burned out in the four years of medical school. Perhaps being a few years older than the average medical student has given me the emotional maturity to better deal with life's ups and downs, but if this article is an accurate reflection of the system in place in the US, I think my coping skills might have been pushed much closer to the limit there. Sure, the firehose of information has always been there, as was the pressure to excel, but to a much lesser degree because internship placements in Australia has nothing to do with one's rank in medical school. Any lack of sleep I have had was due to things unrelated to medical school; I don't remember any incidents of hazing by senior students and residents. In general, I never felt that I was alone in the course. Everyone I know has helped one another the whole time, whether it was to discuss the finer points of some intricate metabolic pathway or to lean on another's shoulder for emotional support. I would say camaraderie and cooperation are the better words to characterize the last four years.

I am not saying the medical school system in Australia is better than that in the US. The competitiveness of US medical schools is the impetus behind the constant innovation, for example. But for my own sanity and mental health, I am glad that I have been able to enjoy the relative tranquil four years in Australia.

Playing House

During a teaching session with one of the pediatricians today, I felt like we were the characters on House.

We saw a thirteen-month-old baby girl who was admitted to the ward yesterday. Through her mother, we learned that the baby had a previous history of Hand, Foot and Mouth Disease, which is a viral infection that happens commonly in children. It ran its course and she got better. Then her mother noticed a rash and diffuse redness in the area covered by the diaper. The mother treated it like a diaper rash. After a couple of days, the baby had not passed any bowel motion and was crying incessantly. The mother thought she had constipation and gave her some enema. The baby opened her bowel but was still unwell. At this point, the mother noticed that one of the baby’s legs was swollen from the hip to ankle and that she was spiking fevers intermittently. The mother finally brought the baby in to the children’s hospital Emergency Department. After having five different doctors taking a history from her, the mother clued in to the fact that the doctors were suspecting a non-accidental injury – i.e., child abuse. After a skeletal survey of the baby turned out normal, more investigations revealed the final diagnosis: the baby had septic arthritis of the hip. Ok, so the diagnosis was not House-worthy, but the process just made me think of the show.

There we were, three med students taking turn asking the mother the history yet again. Each time we were lead down the garden path, only to find that each piece of new information made us do a complete U-turn and think about a different process. Sure, all we did was take the history, we didn’t do any of the crazy things on House like going to the patient’s home and digging up the sandbox (as if doctors really do that in real life). Unlike House, our clinical coach, the pediatrician, was actually very nice to us and to his patients. So maybe it wasn’t like House after all, but I really enjoyed the exercise.

Going into the rotation, I didn’t think I would like pediatrics that much. But I think it’s growing on me.

Baby Check

I enjoy going to the neonatal ward. With all those chubby newborns and happy parents around, you can’t help but smile and share their joy. Yesterday I followed a resident on the ward and did a few well baby checks, which is one of the skills we have to learn during this rotation. Before each newborn is discharged, they are given a once-over by a doctor to make sure they are normal beyond having ten fingers, ten toes, and no obvious deformities.

Like everything else in medicine, there is a system to doing a baby check. You literally go from head to toe and front to back to examine the baby. I especially enjoy doing the primitive reflexes like the grasp reflex in the hands and feet, a telltale sign of our arboreal ancestry, and the Moro reflex, which is believed to be the only unlearned fear in the newborn. Today we had our baby check skills assessed by the neonatal consultant. The way I interacted with the baby I checked must have looked really natural, the consultant asked me afterward if I have kids of my own. Well, besides the four babies I delivered during the O&G rotation, yesterday would have been the first time I handled newborns. So maybe I do have a knack for handling little babies.

In Retrospect: Venice

Not much needs to be said about Venice. Everything about it makes it an attractive destination: the labyrinthine canals, the history behind every building, the festive atmosphere, those gondolas, the colorful houses, even the throngs of tourists. My short trip to Europe with my sister in September 2002 included Venice in the spur-of-the-moment itinerary. Even though we only stayed for two days, the time was well spent getting lost in the backstreets, island-hopping by water-taxi, and filling my daily quota of gelati.

Venice is a collection of islands scatter through the lagoon, with the main island connected to the mainland by a train bridge.

View of San Marco Square from the poor-man’s gondola – the utilitarian water-taxi

San Marco Square was deserted in the early dawn.

At this early hour, the famous and famously annoying pigeons were the only visitors to San Marco Basilica and Campanile.

The gondolas were moored to pylons at the end of San Marco Square with San Giorgio Maggiore Island in the background.

Later in the day, the gondolas would be put into service for all the tourists who wanted that romantic ride through open sewage, er, I mean the canals.

The juxtaposition of gondolas and a warship

The water lapped at the edge of San Marco Square. Flooding has become a common occurrence in recent years due to both the gradual sinking of the city and rising level of the sea.

Gondolas going under the Bridge of Sighs

Get your tschochke along the waterfront

Art student or watercolor master?

While gondola rides are considered a must-do in Venice, we got around by the much more utilitarian water-taxi.

Just a quiet corner in some back canal

All the ubiquitous gondolas were starting to make the whole place feel like a theme-park, only tourists were riding them, after all.

Out on the Island of Burano, the residents must have been competing to see who has the house with the loudest colors.

An American suburban neighborhood association president would surely go apoplectic upon laying eyes on such gross violation of uniformity and the distinct lack of beige.

Filling up on gelato

Donating to a Good Cause

On Monday I had my car towed to a nearby garage. The mechanic called me the next day and broke the bad news. Just as I had suspected, the engine was completely fried. The cost of repair would come to be about the same as what I had paid for the car two years ago. After thinking about my options, I decided to cut my losses. I will probably only get a token amount if I sell it for scraps. So, just like what my parents did with their dead cars years ago, I decided to donate its corpse to charity. A quick Google search landed me on the website of the Cerebral Palsy League. A couple of phone calls later, my car is officially off my hands.

I hope they actually get some money out of it, because I’d like to think that someone with cerebral palsy will benefit, in whatever little amount, from the death of my car.

A Timely Death

This morning, my housemate borrowed my car to go down to the Gold Coast to pick up some of her stuff. In the afternoon, my phone rings. My housemate asks me how long ago I last put oil in my car. A couple of months ago, I guess. Well, the car is now sitting at a service station next to the freeway exit, completely dead.

I borrow a friend’s car and drive down to Coomera where my housemate is stranded with a carload of her stuff. I try starting my car. Wrrrrrrrr, wrrrrrrrr, wrrrrrrr… The starter works in vain, the engine won’t turn over. It sounds like the engine has had it and decided to call it quits today. Like many old cars, my car has been burning oil every since I got in almost two years ago. I have been anticipating its demise, but have been giving it palliative oil changes. It has surprised me by chugging along with no complaints for the last two years. And apparently, today it has decided to go out, not with a bang, just a lot of shakes and black smoke out of the tailpipe.

I help my housemate transfer her stuff to my friend’s car and head back to Brisbane. My disabled car will have to wait until tomorrow to be towed.

Casting My Ballot

Our election is coming up in exactly three weeks. Last year I put in my request for an absentee ballot just a little too late, so this year I made sure to send in my ballot application early. I spent the whole of last evening online looking up the positions of candidates and the details of all the ballot initiatives. This morning I fulfilled my democratic obligations by unceremoniously putting the completed ballot in the mail. I hope it gets there by November 4th.

Wait, does California count absentee ballots if the race is not too close to call?

Kids Emergency

This week I am rostered on at the Emergency Department. Over the last couple of years, I have been slowly developing a liking to emergency medicine. Even though it is not always the adrenaline-pumping full-resuscitation cases with patients bleeding profusely as doctors bark orders while jumping on the patients’ chests as the stretcher races down the hall – in fact, that’s rarely the case – I really like the variety of presentations that’s characteristic of the specialty. So, I really look forward to my week at the children’s emergency department at the hospital.

Today I am on from 3 pm to 9 pm. This being my first day, I am still trying to find my way around the department. The consultants and registrars are incredibly nice to us. I have noticed that all the pediatricians I have met so far have been good teachers and really pleasant to work with. It makes sense: in order to be able to get kids to cooperate, the doctors just have to be pleasant to work effectively. It is hard enough to get kids to cooperate during examinations, a grumpy doctor would basically make that an impossible proposition.

The kids around Brisbane must have had a rough weekend. Late in the afternoon, the waiting room is filled with kids with various injured joints. As a medical student, all I can really do to help out the registrars and residents is by seeing the subacute cases: a sprained ankle, a swollen thumb, a rugby-related knee injury… Before long, it’s nine o’clock – the end of my shift. I have not had dinner, but I don’t even feel hungry. Normally, by this time, my thought would be on nothing but food and I’d be gnawing on my pen already.

“You coming in tomorrow?” the registrar asks me. “Yeah, three to nine again.” “Good, I’ll be on in the evening again. See you then, I’ll get you to do some good work.” With that, I change into my cycling clothes, hop on my bike, and ride down the quiet road toward home.

In Retrospect: Tiger Leaping Gorge

Tiger Leaping Gorge, the name alone evokes images of peril, mystique, and majesty. In early December 2003 when I was traipsing around southwestern China, I made sure to do the three-day hike through the gorge. It is not in a national park, nor is it a “protected area”. It is simply a place where people happen to live in a stunningly beautiful setting. Two main trails runs through the gorge: the low trail was being expanded to accommodate cars and tourist buses, the high trail, well trodden by villagers living in the area, remained the footpath that connects the little villages that cling on to the side of the steep mountain. The villages made it possible for people who had no camping gear to see the place. I hiked with a small backpack, ate and slept at guesthouses run by entrepreneurial villagers who took advantage of the fledgling tourist industry being developed around them.

The gorge, flanked by the Jade Dragon Snow Mountain on one side and the Haba Mountain on the other, is reputed to be among the deepest in the world. The jagged peaks of the mountains drop almost four thousand meters to meet at the bottom, a mere twenty meters apart at the narrowest, squeezing the upper Yangtze River through a series of cascades and rapids. I hiked the relatively short high trail with a few other backpackers, enjoyed the warm Naxi hospitality, and visited the bottom of the gorge where legend had it that a tiger had leapt across to safety while being chased by a hunter.

Tiger Leaping Gorge is located in northern Yunnan Province in southwestern China.

At the western end of the gorge, the upper Yangtze, also known as Jinsha Jiang or the “Golden Sand River”, flows quietly through relatively gentle terrain.

Upon entering the gorge on the High Trail, the jagged peaks of the Jade Dragon Snow Mountain was in view.

The Naxi House was a little guesthouse run by a local Naxi family. The Naxi people are the predominant ethnic minority group living in the area.

Maize and pumpkins being dried for the winter

Even the view from the toilet was spectacular.

Persimmons being dried in the sun

Higher up on the trail, the full length of the Jade Dragon Snow Mountain came into view.



I spent the night at the Tea Horse Guesthouse, where I was greeted by the owner with nuts, snacks, and a bong with locally harvested “herbs.”

The next morning, it took a long time for the sun to rise above the peaks across the gorge.

After breakfast, the incredibly hospitable Naxi Mama sent us off on our hike.

The people carved out terraces and lived off the land.

The trail wound its way around the mountain, veering precariously close to the edge at places.

Taking a break with Inbal, Keeley, and John

The setting sun covered the gorge in a dramatic show of light and shadows.

The daughter of the owner of Sean’s Guesthouse swept the courtyard clean early in the morning.

The peaks of the Haba Mountain towered over the little hamlet at the eastern end of the gorge.

Every inch of arable land had been converted into terrace fields.

The water buffalo took a break as his elderly owner looked on.

The height of the mountains allowed the sun to grace the bottom of the gorge for only a couple of hours a day.

The river roared through the narrowest part of the gorge.

The vista opened up again at the eastern end of the gorge.

Pre-Approved Straightjackets

Seeing how all of us are going to be doctors and earning an income in little more than three months, the university medical society organized a “Finance Evening 2008” tonight in case we don’t know what to do with all these money we’ll be making.

We gathered at the auditorium. A bunch of people in spiffy pin-striped suits took turn and gave us talks on the ins and outs of managing personal finances and services their companies offer. New words were being thrown around: salary packaging, superannuation, negative gearing, capital protected borrowing… I’ll have to look up these words later, but I did learn that, apparently, there are so many ways for these companies to minimize our taxes – and they are all legal. I’m listening, tell me more…

In the middle of their talks, almost every company told us about these pre-approved lines of credit up to $10,000 sitting there waiting for us as soon as we start working. And then there are car loans and 100% home loans. They are practically throwing money at us. I guess the credit crunch in the US has not come across the Pacific yet. Some may salivate at these “generous” offers, but, to me, each one of these pre-approved loans dangling in front of us looked like someone holding up a straightjacket, just waiting for us to turn around and put our arms through, then ziiiiiiip, we’re trapped for the next thirty years. I am already graduating with a bunch of mortgage-size student loans; the last thing I need is another loan on top of it, no matter how favorable the terms may appear to be.

So, no, I don’t need a new car, my little three-cylinder Daihatsu with 240,000 km on it will do just fine, until it dies. House? I’ll be okay living in my rented hovel as long as my net worth is in the red. No, I don’t need a line of credit either. Now, about that tax minimization…

The Beginning of the End

Yes, it’s the last rotation of medical school! But, sigh, it’s arguably also the toughest one – pediatrics. It’s like everything we learned in the last two years all rolled into one: internal medicine, surgery, psychiatry, emergency medicine, and all those subspecialties like nephrology, cardiology, radiology, and whatever-else-ology. I thought the O&G rotation was busy, but by the looks of it, this rotation is going to be full-on. Goodbye, weekends.

In Retrospect: Bagan

I had never heard of Bagan until I went to Myanmar (a.k.a. Burma) in February, 2004. It is THE place that gave Myanmar the nickname “The Land of Pagodas”. With thousands of temples and pagodas in various styles and sizes built between the 1000s and the 1200s while it was the capital of the Burmese Empire, Bagan exuded an air of otherworldliness. I stayed in Bagan for four days and explored on a rented bicycle the maze of dirt tracks connecting many of the pagodas scattered throughout the plains. It would take someone with a degree in archeology and Burmese history to fully understand the different styles and significance of the pagodas. Content with a simple description and explanation from my Lonely Planet guidebook for the major pagodas, I just enjoyed the artistry of the architecture and the relative isolation of the place. Pagoda fatigue notwithstanding, I relished the moments of watching sunsets while perched atop one of the taller pagodas, enjoying the delicious local food at roadside restaurants, and talking with the locals at juice stands and at the riverbank.

Sunrise from one of the smaller pagodas near my guesthouse

From the top of Shwesandaw, the countless pagodas dotting the now parched plains came into view. The lush vegetation would return when the monsoon came later in the year.

With very little vehicular traffic around, the trishaw was a cheap and efficient way for people to get around.

Vendors hawked souvenir at the more popular pagodas.

Shrines like this one, scaled to the appropriate size, are always found inside the pagodas.

This little kid sat with us at dinner. He was wearing thanaka on his face like many children and women in Myanmar.

This lady at our guesthouse made thanaka by grinding a log of thanaka wood on a piece of stone. Thanaka is worn as a cosmetic, sunscreen, and skin conditioner mostly by women and children.

With the cooling sensation of the freshly applied thanaka on my face and the drafty longyi tied around my hips, I was now ready for the oppressive heat of the dry season.



Lacquer ware was a famous local craft.

When parched from riding around the dry dirt tracks, a glass of freshly squeezed sugar cane juice was all you’d need.

Goats grazed in the shadows of the Ananda Temple.


Workmen repairing a sign in front of one of the pagodas


Ananda Temple, like many of others here, was still being used by the locals as a place of worship.


The afternoon sun streamed through a window inside the Ananda Temple.

This gilded statue of Buddha received many offerings from the locals.






Dinner consisted of rice with little dishes of delicious Burmese curries.

Sunsets were always magical in a setting like this.




The lifeline for much of Myanmar, the Irrawaddy River is a place where people do their daily bathing and washing.