Health for Wealth Day 11 - UN & TRCS

UNAIDS - United Nations

Yet again, we arrived at our first destination, the United Nations, extremely early. The bus drove us to the Grand Palace area just down the road and we had time to have a look around and take a few photos. Since 1792, the palace has been the official residence of the Kings of Siam, the Royal court and the administrative seat of government.

United Nations Building, Rajdamnern Nok Avenue, Pranakorn, Bangkok 10200

Upon entry we were required to go through security, have our bags x-rayed and hand over our passports in exchange for a name and security pass. We made our way to a small board room within the UNAIDS department and had the pleasure of meeting Steve Kraus. Yes, Steve Kraus, the Director of the Regional Support Team for Asia and Pacific, a pretty big deal! We were all buzzing and in that moment I felt so privileged to have such an opportunity. He also gave praise to Australia's financial and technical involvement and support of UNAIDS, outlining that many interventions have so far proven successful, e.g. safe injection sites and opiate substitution therapy.

VIP for a day

*there is an abundance of information about HIV/AIDS in Asia and the Pacific and regarding strategies to decrease new infections, reduce stigma and increase education, but I will just outline some basic information that I learnt during my visit*

HIV and AIDS estimates in Thailand in 2011:

• Number of people living with HIV - 490,000
• Adults aged 15 to 49 prevalence rate - 1.20%
• Adults aged 15 and up living with HIV - 480,000
• Women aged 15 and up living with HIV - 200,000
• Deaths due to AIDS - 23,000
• Orphans due to AIDS aged 0 to 17 - 250,000
• 70% of new HIV infections happen in 27 provinces          (Source)

(Image source)

Epidemic is concentrated among key populations:

• People who inject drugs
• In some geographical locations, over 50% of PWID are living with HIV
• Female sex workers
• Clients of female sex workers
• Men who have sex with men
• 7-31% of MSM are HIV+, and this % is on the rise especially in large cities and popular tourist locations
• Male sex workers
• There is generally a higher % of male sex workers with HIV than female sex workers, and is as high as 18% in geographical hotspots
• Transgender and Transgender sex workers
• There is currently no data on population sizes and limited data on HIV prevalence
• Where there is data, it indicates high prevalence in cities

UNAIDS 10 TARGETS AND COMMITMENTS

1. Reduce sexual transmission of HIV by 50% by 2015
2. Reduce transmission of HIV among people who inject drugs by 50% by 2015
3. Eliminate new HIV infections among children by 2015 and substantially reduce AIDS-related maternal deaths
4. Reach 15 million people living with HIV with lifesaving antiretroviral treatment by 2015
5. Reduce tuberculosis deaths in people living with HIV by 50% by 2015
6. Close the global AIDS resource gap by 2015 and reach annual global investment of US$22-24 billion in low- and middle-income countries
7. Eliminate gender inequalities and gender-based abuse and violence and increase the capacity of women and girls to protect themselves from HIV
8. Eliminate stigma and discrimination against people living with and affected by HIV through promotion of laws and policies that ensure the full realisation of all human rights and fundamental freedoms
9. Eliminate HIV-related restrictions on entry, stay and residence
10. Eliminate parallel systems for HIV-related services to strengthen integration of the AIDS response in global health and development efforts

Division of labour:

UNAIDS brings together the resources of 11 UN system organisations for coordinated and accountable efforts to unite the world against AIDS. A division of labour guides the support offered to ensure that countries receive the best technical support and avoids duplication of work in specialised areas.

• UNHCR - The Office of the United Nations High Commissioners for Refugees
• UNICEF - United Nationals Children's Fund
• WFP - World Food Programme
• UNDP - United Nations Development Programme
• UNFPA - United Nations Population Fund
• UNODC - United Nations Office on Drugs and Crime
• UN Women
• ILO - International Labour Organisation
• UNESCO - United Nations Educational, Scientific and Cultural Organisation
• WHO - World Health Organisation
• The World Bank          (Source)

Stigma and discrimination still remain to be large barriers impeding effective HIV responses. So what is being done?

• Since 2010, China, Fiji and the Republic of Korea have all revoked travel restrictions for people living with HIV
• India, Indonesia, Papua New Guinea and Thailand have implemented programs to ensure that law enforcement does not pose as an obstacle to HIV treatment and prevention
• In Thailand in 2011, more than 60% of people eligible for antiretroviral therapy were receiving it
• The government is funding more than 84% of the HIV response with domestic resources
• Objectives include: support schools to teach sex education and promote safe sex for sexually-active youth; improve access to condoms; screen donated blood for HIV and appropriately used blood and blood components in treatment; provide treatment and holistic care to people living with HIV, their families and other affected people; create opportunities for learning and training to improve understanding about basic human rights and sexual rights among service providers and the general community with the aim of reducing stigma and discrimination; empower key affected populations so they know about their rights and can access protection services; and change attitudes of society in Thailand.         (Source)

"Today, we have a chance to end this epidemic once and for all. That is our goal: Zero new HIV infections, Zero discrimination, and Zero AIDS-related deaths." 

United Nations Secretary-General Ban Ki-Moon, at the United Nations General Assembly High Level Meetings on AIDS, June 2011.

"Don't be afraid to be a change agent." 

Steve Kraus, at the meeting with 20 University of Technology Sydney students, 11th July 2013.

More information on UNAIDS and the response in Asia and Pacific 

I found this presentation extremely interesting and educational and I will take a lot of this knowledge with me. I believe that my role as a Registered Nurse when caring for patients infected allows me to be supportive and reduce stigma and discrimination, thus aiming to reduce barriers to accessing and adhering to treatment. Despite developing countries having a higher prevalence of HIV/AIDS, Australia has seen a notable rise in HIV infections in the last year, reiterating the worldwide need for increased awareness and education, access to holistic care and treatments, and well-equipped health professionals free from stigma.

The first REAL coffee of my trip at the UN!

Thai Red Cross Society

The TRCS was founded in 1893 with the objective of alleviating suffering. In 1920 it became recognised by the International Committee and quickly became the largest humanitarian society in the country.

4 Chang Wat, Bangkok 10330

We were welcomed immediately upon our arrived at the Thai Red Cross Society (TRCS) and had a few group photos taken. We were then led to a meeting room for a presentation on the TRCS and the work they do in responding to disasters in Thailand. Wanpen Inkaew and Somjinda Chompunud delivered presentations to us containing the following information and more.

The TRCS functions in four main areas:

• Medical and health care
• Disaster preparedness and response
• Blood transfusion services
• Quality of life promotion

Disasters in Thailand
Natural: flood, drought, storm, landslide, tsunami
Made-made: fire, chemical and hazardous material incidents, transport hazards, sabotage threat


TRCS response to the 2011 floods
Between 25 July and 9 December 2011, the Department of Disaster Prevention and Mitigation reported that as a result of tropical storm "Nock-Ten" a total of 65 provinces were affected - in 684 districts, 4,917 sub-districts, 43,600 villages - affecting 13,570,873 people, 680 people died and 3 people missing.

1. On 13 December 344,012 relief kits and 324,944 packs of bottled water were distributed
2. Between 22 September and 2 December, 4 mobile relief kitchen units prepared 439,830 meals for affected people in 8 provinces
3. Between 1 October and 9 December, 2-4 mobile medical units traveled by flat bottom boats to reach 13,393 affected people in 7 provinces. Each unit consisted of a doctor, pharmacist and nurse.
4. 22 flat bottom boats evacuated 78,680 flood-trapped people in 13 provinces between 6 September and 10 December
5. Between 6 September and 10 December, 8 water purification units were sent to 6 provinces and produced 5,160,000 litres of water for 258,000 affected people
6. 448 shelter box sets were distributed. Each box supported a family of 5 people and consisted of a tent with a raised floor, bedding, kitchen utensils and daily necessities
7. 20 floating toilets were provided in Pranakom Sri Ayutthaya and Nonthaburi provinces
8. 583 boats were distributed to affected people in 9 provinces
9. 48,000 ready-to-eat meals were distributed to 7 provinces

The Thai Red Cross College of Nursing

The College was established in 1914 as a contribution of Queen Sripatcharintra - Wife of King Rama V and the first present of the Thai Red Cross Society. It is recognised as the first nursing school that offered a general nursing practice program in Thailand and initially offered a three-and-a-half year nursing and midwifery program up to 1964. Currently the Bachelor of Nursing Science program and post-graduate programs are offered at the college with 700 students enrolled, of which only 5% are male students. The college offers onsite dormitory living to female students. To date, over 8,571 Registered Nurses, 976 Nurse Specialists and 1,687 Practical Nurses have graduated from TRCN.

Disaster education

There is no official disaster nursing course in Thailand's educational system (and certainly not in Australia's educational system either, well, at least not that I know of!). TRCN's current curriculum incorporates 3 credits of disaster nursing (2 credits of theory and 1 credit of practical demonstration) and integrated content of emergency/community health nursing in the third year of study. Supportive teaching materials include magnetic models of disaster situations and interactive computer games for triage care during earthquakes, floods and fires.

Costs

• The BNS tuition fee for full-time study is approximately 20,000 baht per semester
• Approximately $8,422 AUD for the entire degree
• Accommodation costs 20,000 baht per semester
• Approximately $2,105 per year
• Scholarships, awards and financial assistance from the college and the government are available to eligible students

I was quite impressed by the all the work the TRCS does in response to humanitarian crises and they appear to be well equipped. In operation is a Disaster Health Training Centre where child protection is its first priority and creates safe places for children separated from their parents or orphaned. The centre trains people to be capable and resourceful volunteers, and these volunteers are looked after during and after their volunteer work through activities such as yoga and meditation to alleviate stress. The TRCS are also very focused on improving disaster care education and are currently working on improving the nursing syllabus and textbook. I hope that one day I am able to return to Thailand and participate in volunteer work; perhaps with the TRCS or another organisation that helps people in crises in rural and remote areas!

Health for Wealth Day 10 - RSU

Rangsit University

The drive this morning took us north beyond the province of Bangkok and into Pathum Thani. It was an enjoyable drive with changing landscapes, vast street vendors, and a display of extreme living conditions.

52/347 Muang Ake, Phaholyothin Road, Lak Hok, Pathum Thani 12000

In the cafe we were met by Jeffrey Wollentin, the Director of International Affairs. He was extremely welcoming and lead us to the board room where we were then introduced to the Assistant to the President for Internationalisation, Jeroen Schedler. He opened the presentation with an extremely interesting and educating talk about Thailand and Pattaya as he was made aware of our visit, and empowered us to be adaptable, accepting, and culturally competent people. A great example he used is as follows: a meeting may be scheduled for 10am, yet Thais may arrive any time after 10:15am. Is that annoying and frustrating because they are not on time? Or is it smart and advantageous because it's give people time to talk, network and share ideas, resulting in a smooth-running meeting? Morale of the story - be open-minded to different ways of doing things, develop strategies and coping mechanisms, and not block our minds with opinions and miss potential opportunities and experiences.

The presentation went on to introduce the history of RSU and the courses it provides. RSU is one of six universities/colleges to offer an International Nursing Program in Thailand - these programs are classified as 'International' as they incorporate English into their teaching. However, RSU is the only institution to offer a unique overseas component, with students completing their fourth year of study in Sweden.


Rangsit University history:

• Opened in 1986 as Rangsit College, only accepting 50 nursing students
• In 2000, the Exchange Nursing Program started
• In 2002, the Master Degree Nursing Program commenced
• 2010 marked the beginning of the Double Degree Nursing Program, containing an extra 20 credit of English
• Following the floods in late 2011, the gardens were spray painted in preparation for early 2012 graduation ceremonies

Bilingual Double Degree 4-year Nursing Program
The double degree is made possible with cooperation between the School of Nursing at Rangsit University, Thailand (RSU) & School of Health, Care, and Social Welfare at Malardalen University, Sweden (MDU). Total tuition fees: 720,000 THB

The two degrees studied are a Bachelor of Nursing Science (RSU) & a Bachelor of Science in Caring Science (MDU). The structure provides good value and balance containing anatomy, physiology and pharmacology from RSU, and 'caring science' and the art of nursing from MDU. The fourth year of the program is taught in Sweden. English is used in the general education and elective courses, and bilingual language is used in the 'Foundation' and 'Nursing' courses at 50/50 in proportion.

Thai teaching staff
A Student Nursing Council handles affairs on campus. Thai teaching staff require at least a Masters Degree to be able to teach at the university. As well as maintaining Thai culture and traditions, they work with international staff to help introduce and foster new ideas.

Dr. Kaitsara Sen-Ngam, Assistant Professor of the Bilingual Program, and Pranee Tudsri (RN, MA) then gave presentations about the current health of Thailand and child health care. I found this to be the most educational presentation of our Experiential Program and found it interesting to learn about the health of a developing country. I will share some information below.


Health of the population of Thailand

• 0-14 years of age = 25.5% of population
• 15-59 years of age = 67.4% of population
• > 60 years of age = 11.1% of population, expected to reach 14% by 2015
• Life expectancy of males in 1964 was only 55.9, increased to 70.6 in 2010 and is estimated to be 76 in 2030
• Life expectancy of females in 1964 was 62, increased to 77.5 in 2010 and is estimated to be 82.7 in 2030
• The elderly are cared for by their families, with many families living in multi-generational arrangements, thus decreasing the burden on the health care system and reducing the risk of hospital-acquired infections
• An arising problem is increasing depression due to decreasing socialisation of the elderly
• Nursing homes do exist but only for the very sick when families are unable to assume care

Major causes of death

The leading cause of death of males and females is cerebrovascular disease, 9.4% and 11.3% respectively. This is followed by road traffic accidents, AIDS and ischaemic heart disease for males (8.1%, 7.9% and 6.4%), and diabetes, ischaemic heart disease and undefined causes for females (8.0%, 7.5% and 7.2%). These causes are not too different from those in Australia. The major causes of death among 0-14 years are perinatal asphyxia, birth trauma, road traffic accident and accidental drownings, and among 15-49 years is HIV/AIDS and road traffic accidents, highlighting a population at risk of HIV/AIDS infection. We were told by Dr. Kaitsara that currently the US has a vaccine for HIV in the works...

Risk behaviours of children and adolescents are eating behaviours, sexual behaviours (thus HIV), drug addiction, cigarette smoking, alcohol consumption and driving behaviour. There are multiple health problems as a result of communicable and non-communicable diseases: diarrhea, acute respiratory infection (with pneumonia being the number one cause of death in infants), dengue haemorrhagic fever, encephalitis, HIV/AIDS, tuberculosis, as well as low birth weight and premature births, obesity, malnutrition, dental caries, asthma, cancer, renal disease, blood disorders, pollution, car accidents, water-related accidents, and mental health problems. Drownings in Thailand are largely related to low safety standards and this can be seen by children swimming in rivers and canals unsupervised and with no barriers to prevent entry to the water. This may be due to the water being an important transport route in Thailand. There are also currently no government campaigns or programs. As I have mentioned in a past post, mental illness are still taboo in Thai culture with many individuals seeking help the traditional way. With temples still the first stop for those experiencing mental and emotional ailments, awareness of mental illnesses is slowly increasing in Thailand and the Bachelor of Nursing Science includes 6 credits of study about mental illness. Wat Pho is an example of such a temple that contains monks who may specialise in medicine, meditation and oriental medicine.

Health service system in Thailand

Family-centred care

It has been recognised that the family is the major participant in the assessment and treatment of a child and adolescent. Families have the right and responsibility to participate individually and collectively in determining and satisfying the health care needs of their child.

Primary care

For primary care to be successful it must be accessible, holistic and provide continuity of treatment. Use of appropriate technology allows responses to reflect the changing health needs of the community and individuals.

Child health services

Antenatal care:

• Health promotion, preventative health services and health education
• Prevention and treatment of anaemia
• Tetanus toxoid immunisation

Postnatal care:

• Promote breastfeeding
• Nutrition assessment
• Lifestyle and emotional counselling
• Family planning

Child health care (0-5):

• Immunisation completion
• Promotion of good nutrition and eating habits
• Assessment of growth and development
• Home visits

It was then time for lunch where there was a huge buffet put on for us and we were able to sit and converse with some of the current nursing students of the university. We had some students sing their nursing song to us in Thai and handover beautiful flowers as a welcome gift, and then had a quick tour around the School of Nursing and were shown some of their clinical laboratory rooms which were quite impressive. Again, I instantly felt like friends with these students thanks to the common interest and passion in nursing. They were all so eager to talk to us and practice their English communication.

Overall, I was extremely impressed by everything we were told and what we saw around the campus. I am a little jealous of the double degree RSU offers, and would have definitely been interested in such a course had it been offered upon my enrolment in Sydney. They have a great emphasis on international development and have relationships with many universities around the world including the University of Queensland and Griffith University in Australia. It was also great to gain a broader perspective on health issues and needs that are impacting on a developing country.

Health for Wealth Day 9 - Vejthani Hospital & Siam Reiki

Vejthani Hospital

It was an early start this morning - to allow plenty of time for traffic, of course. We arrived at the hospital about 30 minutes early but that meant time for coffee! I was really excited for a presentation about maternity and paediatric care, but it was an opportunity for the hospital's facilities to be put on show from an executive perspective, unfortunately again the meeting not matching the itinerary's focus.

1 Ladprao Road, 111 Klong-Chan, Bang Kapi, Bangkok 10240

Vejthani Hospital was established in 1994 with the vision to be the leading private health services provider dedicated to delivery of high quality responses to society's changing health care needs.

Hospital capacity:

• 12 storey building (34,964 sq. m.)
• 500 inpatient beds
• 95 Grand Single rooms, 10 Suites, and 11 VIP Suites
• Over 300,000 patients per year
• International patients from over 40 different countries
• Most patients are Arabic

Staff:

• Over 700 full-time employees
• Over 300 physicians and dentists
• Over 200 nurses
• International Correspondence team
• Overseas offices in USA, UK, Australia, Canada, China, Bangladesh and UAE

Inpatient services:

• Adult Intensive Care
• Renal Dialysis Unit
• Paediatric Intensive Care
• Grand Wing Inpatient Department
• Arabic Inpatient Department
• Paediatric Inpatient Department

Outpatient services:

• 24 hour emergency care - Ambulance and Mobile Critical Care Fleet
• Consult rooms and peaceful environments for patients awaiting test results, including an area for massage
• Outpatient surgery
• Clinics including - allergy, breast, cardiology, colorectal surgery, dialysis, ENT, endocrinology, eye, gastroenterology and hepatology, hand, hematology, infectious diseases, nephrology, neurology, neurosurgery, obstetrics and gynecology, orthopaedics, plastic surgery, psychiatry, radiology, rehabilitation, respiratory, rheumatology, skin laser and cosmetics, spine, thoraric, ART (assisted reproductive technique), TJR (total joint replacement), and urology.

Facilities and Services:

• 3 separate check-in and service counters
• Arabic
• Thai
• International
• Multilingual interpreters
• Restaurants, coffee shops, Thai massage, and book and toy stores
• Internet services and WiFi
• 500 vehicle carpark
• Airport transfers and travel arrangements
• Prayer rooms
• In-house serviced apartments and hotel accommodation
• Multiple customer contact lines: English, Arabic, Bangla, Myanmar, Russian and Ethiopia hotlines

What seems to be a typical view from a private hospital ward room

The hospital prides itself on its specialisation in ART and TRJ, adopting computer navigation and minimally-invasive techniques. New technologies extend to its Yuyama automated pharmaceutical robot, allowing for electronic medication ordering and smart dispensing (but not administration to the patient!). I felt as though there was still a huge focus on plastic and cosmetic surgery with the tag line being "Beauty is within reach".

We were given a tour of the hospital by Sawitree (DNS) and it all felt much the same to every other private hospital we had visited. I left a little confused as I asked one of our hosts about mental health facilities and I was told that no mental health facilities exist in the hospital, however the website states that there is a psychiatry clinic. Mental illnesses are still taboo in Thailand and temples are usually the first and only place where people who suffer from mental ailments go to seek help. Check out this article for an interesting read about participation of religious organisations in mental health care in Thailand.

Interestingly we also learnt here that organ donation is not yet legal in Thailand, and there is no voluntary system for donations, including bone marrow. Only family donations are accepted from living donors between 18-65 years old. In saying that, Australia is currently ranked only 17th in the developed world with its "opt in" consent law. Countries including Spain, Belgium, France, Norway and Italy achieve much higher donation rates with "informed consent" laws, where everyone is considered a donor unless they specify otherwise.

I could go really on with my reflection contrasting various aspects of Australia health care and its facilities to Thailand, but I will leave you with some food for thought. In all private hospitals we have visited to date there has been no mention of education regarding illness prevention or health promotion. Is this contributing to the focus of plastic and cosmetic surgeries? Rather than investing in pharmaceutical robots worth millions, could money be better spent, with money redirected to the public/rural/community sectors? 

Institute of Applied Holistic Health Sciences

A change to our afternoon itinerary had the group under the impression we were off to learn about holistic care of the elderly - sounded strange as we had learnt that Thailand doesn't have 'nursing homes' like Australia does. Where we found ourselves was Siam Reiki at the Institute of Applied Holistic Health Sciences with two Reiki Masters: Katherine and Mohana.

Siam Reiki: 4115 Rama IV Road, Phra Khanong, Bangkok 10110

Having not heard much about Reiki in the past I was quite interested in this different approach to health and healing. Reiki (meaning universal energy) is a hands-on therapy focusing on energies and vibrational frequencies, and works by expanding auras and the seven chakras. A reiki therapist acts as a channel so that the energy is transferred to the recipient and thus identifying areas of congestion. The causes of these blockages can be spiritual, mental, emotional or physical and are usually detected before physical symptoms become apparent.

I won't go in to too much more detail, but reiki supports medical procedures and practices and neither conflicts or interferes with treatments. It aims to assist in healing of the body quickly and naturally. Reiki is also a consistent method for relieving and reducing stress, tension and hypertension by releasing congested energy produced by day-to-day activities.

Siam Reiki was founded in Bangkok in 2008, with the Institute of Applied Holistic Health Sciences established in 2010 in response to the increasing need for international standards of quality control and procedures in training. Courses are run to include an assessment of students to ensure the development of competent practitioners, and courses are recognised professionally enabling practice in medical, spa and health resort areas. Overall, it was a very interesting experience and I do believe there is a place for holistic practices in modern health care.

Upon arriving at the hotel, it began to rain very heavily. Kate and I were keen to check out the department store in Siam Paragon, and I bought myself another pair of shoes before heading to MBK for another wander around. It was a very successful shopping expedition!

Shopping in MBK: Sunscreen not available in Australia!

Health for Wealth Day 8 - Market tour

Back to Bangkok! YAY! This time, I was awake for the 3 hour bus ride but opted to stay onboard during the pitstop. It was raining heavily (first day of rain!) and I wasn't hungry. Kate and I were actually quite productive during the trip, and spent most of our time brainstorming for our blog posts and reflecting on all our visits. Thankfully the rain eased off as we cruised back in to Bangkok and just in time for the Indian Market tour.

Somewhere along a highway

Back at the Ibis Siam. View from room 1020

We had just over an hour to do our own exploration before meeting down the road. It was hot, cramped and smelly. Plus, I have a feeling we weren't at the Indian Markets - I think we hadn't walked far enough and were still in China Town. I didn't purchase anything and unfortunately we all left fairly unimpressed.

Motorbikes and scooters squeeze through the crowds

A procession of monks

A driver waiting for his next fare

It was a quiet night tonight thankfully. Dinner consisted of noodles from the 7/11 downstairs for 13 THB. May not sound exciting, but they had dehydrated prawns, I was tired, it was easy to prepare, and it was tasty! I wish I could fill my bag with these noodles to bring home!

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Travel tip 11: Drinking water is extremely cheap: around 13 baht from the 7/11 for over 1L. Also, you are usually provided a bottle or two upon check-in at your hotel, and bottles are supplied on bus tours.

Travel tip 12: Both Ibis hotels had powerpoints with built-in adaptors which was handy for my Australian devices (and meant both powerpoints could be used at the same time)! Still take your adaptors, and get one that also has a USB plug, saving the need for a separate adaptor for your USB-charging devices.

Health for Wealth Day 7 - Church service

Baan Jing Jai Project

At 9:15am our bus left, bound for a Christian church nestled off a main road in Pattaya (not sure of its address). I was under the belief that we were spending the morning with the children, but they were no where to be seen as we took our shoes off and entered the church. The group was a little confused; the entire service was in Thai. Despite the fact that not many of us are religious or practicing any religious customs, it still was nice to experience something a little different, and we were all looking forward to seeing the kids!

With the 95% of the Thai population Buddhist, a Christian Church is a rare sight

Through the service they suddenly arrived! The kids hustled in, found a seat, and couldn't contain their excitement. A few boys in front of Kate and I couldn't help but turn around and steal a couple of cheeky glances. A few songs and they were back downstairs, and Kate and I were following shortly after. I won't lie - I was falling asleep. I did enjoy the singing, but everything in between... I obviously couldn't understand it.

(Photo courtesy of Lisa)

Luckily Emma managed to get us out of singing a song during the service. The song we had chosen was "Home Among the Gumtrees" and would have been totally inappropriate without the kids, especially because we had planned on doing the actions to the chorus! So the song was saved for after lunch (which was aroy, aroy - delicious, tasty!), and it was a hit for the audience, who requested an encore of the chorus!

Following lunch and dessert, it was time for the kids to head back to the orphanage. It was such a hard goodbye! I think I would have preferred to have ended our contact at the orphanage yesterday and left it on a happier note. I was also shocked and heartbroken to see most of the kids climb into the back of a taxi, and a lucky few got to ride in the back of a not-so-crammed ute. This was a very stark contrast to Pattaya Orphanage and their donated bus, and for me raises the issue of transport safety... 

It was then our time to leave the church and we were taken to view the new land that is awaiting development of the new orphanage. I didn't catch much of what was being said and after a quick look on the internet I found some information regarding the new project.

Housing project

• Late 2010 saw the beginnings of a project to construct a purposed-designed facility to accommodate more than 100 children due to Baan Jing Jai's expansion
• In March 2011, a suitable site for the home was purchased with money previously collected plus a bridging loan
• The new site is approximately 6,750 sq. m.
• Situated approximately 1km from the junction at the School of the Regents, off Highway 7
• The initial building will contain:
• Bedrooms for 40 boys and 40 girls
• 20 cot nursery
• First aid room
• Library
• Art room, music room and leisure room
• Offices
• Kitchen and maintenance areas
• There will be space for a large playground and garden areas
• Target of 18,500,000 baht to complete the project
• 10,783,116 baht raised so far
• A committee has been established to organise and raise funds required to build the new orphanage and oversee the construction process
• This committee is completely independant from the day-to-day fundraising for the Home which continues as usual

Source: www.baanjingjaifoundation.org/project.php

A 2-hour nap was enough to recharge the batteries and we were out again. Dinner was at the same restaurant as yesterday, and this time it was seafood spaghetti - amazing! We had tickets for a 9pm show at Tiffany's which I had been so excited to see (probably the only thing I actually wanted to do while in Pattaya!). It is the original transvestite cabaret show in Pattaya and is in its 38th year. Tiffany's is voted number 4 in the top ten best transvestite shows to see around the world (after Moulin Rouge Paris, Siegfried & Roy Las Vegas, and Mysters Las Vegas). The show was truely incredible and I was mesmirised by the stage sets, sparkling dresses and huge head pieces. Well worth the 800 baht! To top off a good night, a few of us popped down to the bar at the Holiday Inn and enjoyed a mojito.

Nothing had changed my opinion of Pattaya though: hot, seedy, loud and lit-up; bars filled with women in tight short shorts and crop tops, swaying around poles, completely expressionless; as seedy men sit around glaring up at them, yet still noticing us foreigners walk past and wasting 5 seconds of their time to yell out at us. "Where are you ladies going by yourselves?" *cringeworthy* Maybe a few more days would have allowed for further exploration, but for now, I was happy that it was our last night in this uncomfortable tourist beach-side city.