• Thailand,  Travel

    Thailand Travel Itinerary

    Thailand is a country I have always wanted to visit and in February of 2018, we planned out a 10-day trip through the country’s best sites. I had done some research beforehand and came up with this Thailand travel itinerary, deciding the majority of our time would be best spent in Chiang Mai and Krabi. We flew into Bangkok from NYC and stayed at the Shangri-la hotel. I would highly recommend this hotel as it has a prime riverside location (along the Chao Phraya River) and the most memorable dining experience. The breakfast buffet is particularly praiseworthy and you basically have to see it to believe it. We spent two nights in Bangkok, which I think was enough to get a feel for the city and visit the most prominent sites.

    On our first day in Bangkok, we visitied the Grand Palace, well-regarded as a must-see site. Made up of multiple intricately designed buildings that used to house the Kings of Siam, the court and the royal government, it is an incredible sight. The Temple of the Emerald Buddha is also located here and is considered Thailand’s most important Buddhist Temple. Of note: proper decorum and dress is very important to Thailand culture and men and women are required to wear long sleeve shirts and pants as well as socks when visiting the Temples.

    Across the street from the Grand Palace is the breathtaking Wat Pho Temple also known as “the temple of the reclining Buddha.” It is one of Bangkok’s oldest temples. It houses one of the largest single Buddhas, the reclinig Buddha and contains the most Buddhas in Thailand. Wat Pho was also the first public university in Thailand. There is a school of Thai medicine inside, and traditional Thai massage is also taught there. After a busy day of visiting various temples and historic landmarks, we took a ferry from our hotel to Central Pier, a bustling area with lots of restaurants and shops.

    We started our second day in Bangkok at Wat Traimit, another temple, which boasts the largest Gold Buddha in the world. Afterwards, we headed to the famous floating markets. There are many floating markets in Bangkok, all offering a variety of Thai delicacies. The second night was spent watching a Muay Thai match at the famous Rajadamnern stadium, which as the first Muay Thai stadium in Thailand is a historical landmark. As someone who is not particulalry interested in watching boxing or really any type of fighting, I was pleasantly surprised by what a great experience the show was.

    Our next stop on the Thailand travel itinerary was Chiang Mai, which ended up being my favorite destination. All throughout Thailand, the warm and peaceful nature of its people is palpable, an observation that has left a a long-lasting impression on me, but I think it’s most palpable in Chiang Mai. Chiang Mai, the largest city in Northern Thailand has a lot of historical relevance given its proximity to major trading routes and over a hundred Buddhist temples. We stayed at Pingviman hotel, which I choose for its walkable location in the Old Town, a culturally enriching and authentic part of Chiang Mai. Chiang Mai is such a fun city to explore via walking. There are so many quaint eateries and local spots that add to the authenticity of the region. A main attraction in Chiang Mai is Doi Suthep, a majestic temple on top of a mountain that requires a hike up a long staircase.

    The main highlight of our time there however was visiting the elephant sanctuary. I did a lot of researching when putting together this Thailand travel itinerary to make sure we were going to visit a sanctuary that treated the elephants humanely because there are a lot out there that are abusive towards the elephants (you will hear some horror stories on your trip). The place that kept coming up as a humane destination was Elephant Nature Park, a rehabilitation sanctuary where previously abused and disabled elephants are kept. We signed up for the “pamper a pachyderm” experience where we got to feed the elephants, bathe them and hike with them. They also have a “no ride” policy to protect the elephants. It was such an incredibly peaceful and enlightening experience.

    After 3 nights in Chiang Mai, we were off to the Krabi islands in Southern Thailand. When you start reading about where to visit in the South of Thailand, there are a lot of opinions about where to spend the majority of beach time. The biggest debate is the Phuket versus Krabi one. Of course, Phuket is the more popular destination and typically the one tourists flock to, but I’m really glad we chose to spend most of our beach time in Krabi for several reasons. While Phuket has more beaches, the beaches in Krabi are more aesthetically pleasing in my opinion. The Krabi islands are known for their famous limestone formations, emerald pools, hot water springs and rugged charm. Phuket is also A LOT more congested and touristy as noted earlier although there is more of an active nightlife, more shopping areas and fine dining. In Krabi, there is more nature and less people, traffic and noise. Phuket definitely has more hotels and more of a city feel, and Krabi is more remote, but my intention for the second part of our trip was to be in a more secluded setting.

    Once we decided to spend 3 nights in Krabi, we had to pick which area we wanted to stay in. We chose to stay at Centara Grand Beach Resort and Villas in Ao Nang, which was an incredibly beautiful hotel with a private beach. One thing to note however is that we had to take a ferry to get to the hotel since it is on a remote private beach. Once you’re there, the only way to access the center of Ao Nang is via boat or via the Monkey Trail. We did the Monkey Trail hike for fun and it was short and easy, but sadly, we did not see any monkeys. We ended up doing a 4-island tour from the hotel, which included Railay beach, Poda Island, Chicken Beach and Top Island. I think this is the best way to explore Krabi and get a varied view of what the region looks like.

    Our Thailand travel itinerary concluded with two nights in Phuket where we stayed at Le Meridien, a beautiful beach resort. We spent the first night in Phuket exploring the night life on the famous Bangla Road and it is definitely a sight to see! There are so many bars, lounges, restaurants and other “adult attractions,” but it has a more touristy feel. We spent our last full day and night in Thailand at the resort and enjoyed a fire show on the beach with a Phuket sunset backdrop. Thailand is by far one of my top 5 favorite destinations in the world. There is so much culture, history and an overall sense of calm and peace, which is what I was most captivated by.

    With regard to COVID rules/precautions, here are some things to note:

    • Thailand is currently reporting 20,000-30,000 new cases of COVID-19 a day.
    • As of April 1, 2022, Thailand has relaxed its COVID-related entry requirements.
    • All travelers will need a Thailand Pass to enter the country.
    • There are 3 different entry programs-Test and Go, Sandbox and Alternative Quarantine.
    • While a negative PCR test is no longer required within 72 hours prior to entry, it is still required upon arrival. Travelers will also be required to provide proof of a negative antigen test on day 5 of their visit.
    • The Alternative Qurantine route was for unvaccinated travelers, which originally required a 10-day qurantine upon arrival to Thailand, which will now be reduced to 5 days.
    • Fully vaccinated travelers can either participate in the Sandbox program where they will now be required to quarantine for 5 days as opposed to 7 days upon arrival or the Test and Go program, which involves testing on day 1 and day 5 without a quarantine.
    • Masks are still required in both indoor AND outdoor settings in Thailand

    https://th.usembassy.gov/u-s-citizen-services/covid-19-information/

  • Coffee Chats

    How to celebrate International Women’s Day in 2022

         A message on the International Women’s Day website reads “International Women’s Day is a global day celebrating the social, economic, cultural and political achievements of women. The day marks a call to action for accelerating gender parity.” As a society, we must continually evaluate whether we are indeed “accelerating gender parity.” How do we celebrate International Women’s Day in 2022? How do we honor women, not just on women’s day, but every day? Are we working towards a world where women no longer have to fight for pay equity, paid maternal leave, affordable childcare, equitable maternal care across all racial groups and a plethora of other basic needs? Let’s put our words and social media proclamations into action.

     

    The COVID-19 Impact

         While gender inequity was a problem before the COVID-19 pandemic, the pandemic has further highlighted the challenges women face worldwide in the work force and at home. This UN report summarizes a lot of the gender inequities reinforced by the pandemic. Women earn less than men, have less access to social protections, are more likely to do unpaid work and domestic work and make up the majority of single-parent households. Even before the pandemic, women did almost 3 times as much unpaid and domestic work as men across the globe. As a result of the pandemic, domestic workloads increased and with children out of school, women spent more time caring for and teaching children at home, cleaning, preparing meals, shopping for the family etc. While some governments did attempt to address the economic impact of COVID-19, very little was done to address unpaid work, which was overwhelmingly done by women.

     

    Decreased rates of employment in women

    • Women’s employment decreased by 4.2% between 2019 and 2020 in comparison with men, which was a 3% drop in employment across the globe.
    • In the United States, women have lost 5.4 million net jobs since February 2020.
    • Rates of employment loss were even higher for Black and Hispanic women.
    • Multiple studies have shown that women bear the brunt of the childcare duties and were forced to reduce their work hours, spend more time on domestic duties, and leave work to care for children.
    • It is estimated that the gender poverty gaps will be exacerbated by 2030 with women aged 15 years and older making up the majority of the extreme poor.

    Increased rates of sexual/physical violence towards women

         In addition to the economic and professional toll on women, many women also suffered sexual and/or physical violence with increased rates in the last year. With an increase in violence against women by an intimate partner, they also had fewer options given the lack of financial stability and limited access to social support. Across the globe, 243 million women and girls between the ages of 15 and 49 experienced sexual and or physical abuse in the last year by a partner.

     

    Struggles of women in academic medicine

         On a more personal note, the struggles of women in academic medicine are also astounding. Gender bias is rampant throughout academic institutions and pervades all sectors of medicine. Multiple papers have been written on the setbacks that will be experienced by women as a result of the pandemic in a field where there was already a lot of gender bias and inequity:

    • While there are more women than men enrolled in medical school, women account for only 16% of department chairs and deans in the US and 18% of hospital CEOs.
    • Additionally, only 24% of full professors are women.
    • Women in academic medicine make 90 cents for every dollar made by men in academic medicine.
    • Workplace discrimination is also a problem with 51.3% of female physicians reporting workplace discrimination versus 31.2% of male physicians and more than one third of physician mothers reported maternal discrimination.
    • Female physicians are also 5 times more likely to face obstacles pertaining to career advancement than their male counterparts.
    • Across the world, women make up 70% of health workers and front-line responders yet even in the health sector, the gender pay gap is 28%, which is higher than the overall gender pay gap of 16%.
    • With regard to academic research, fewer women submitted academic research to journals given an increase in domestic workload.
    • Women early in their careers receive about $40,000 less than men in National Institutes of Health funding for their first grant.

    Taking action

     

         We need to first and foremost strive to protect women’s health and well-being by ensuring access to sexual and reproductive health services. This measure includes addressing the health-specific vulnerabilities in underserved communities such as maternal care and taking into account the greater risks taken by health care workers, most of whom are women. We need to implement economic measures for women from underserved communities and re-allocate unpaid and domestic work.

     

       In the United States specifically, we need increased access to paid family leave, paid sick leave, and affordable and quality childcare. The United States is the only high income country without paid maternal leave and a high rate of maternal death due to pregnancy related issues. Black women are dually impacted as there are significant racial disparities across the board and they are 3 times more likely to die from a pregnancy related condition than White women.

     

         On a global level, it is imperative that unpaid care work is recognized and valued. Policies should be implemented to include social protections for unpaid caregivers, increased access to paid family leave and sick leave. We also need to address long standing inequalities such as the gender pay gap and the disparate division of labor at home.

     

      The COVID-19 pandemic has shown us just how precarious the systems we have in place are and how vulnerable populations are impacted the most. When we think about how to celebrate International Women’s Day in 2022, we need to reflect on how far we’ve come and how much we still have left to go and remind ourselves of the question of whether we have worked towards achieving gender parity.

     

    References

    https://www.internationalwomensday.com/

    https://www.unwomen.org/sites/default/files/Headquarters/Attachments/Sections/Library/Publications/2020/Gender-equality-in-the-wake-of-COVID-19-en.pdf

    UN Women and UN DESA (United Nations Department of Economic and Social Affairs). 2019. Progress on the Sustainable Development Goals: The Gender Snapshot 2019. New York: UN Women and UN DESA.

    https://www.ilo.org/wcmsp5/groups/public/—dgreports/—gender/documents/publication/wcms_814499.pdf

    https://nwlc.org/wp-content/uploads/2021/01/December-Jobs-Day.pdf

    Caitlyn Collins and others, “COVID-19 and the gender gap in work hours,” Gender, Work and Organization (2020): 1–12, available at https://onlinelibrary.wiley.com/doi/abs/10.1111/gwao.12506.

    Danielle Rhubart, “Gender Disparities in Caretaking during the COVID-19 Pandemic” (Syracuse, NY: Lerner Center for Public Health Promotion, 2020), available at https://lernercenter.syr.edu/2020/06/04/ds-18/

    Matt Krentz and others, “Easing the COVID-19 Burden on Working Parents,” Boston Consulting Group, May 21, 2020, available at https://www.bcg.com/publications/2020/helping-working-parents-ease-the-burden-of-covid-19

    UN Women. 2020e. “Covid-19 and Violence Against Women and Girls: Addressing the Shadow Pandemic.” Policy Brief no. 17. New York: UN Women. https://www.unwomen.org/en/digital-library/publications/2020/06/policy-brief-covid-19-and-violence-against-women-and-girls-addressing-the-shadow-pandemic

    Woitowich NC, Jain S, Arora VM, Joffe H. COVID-19 Threatens Progress Toward Gender Equity Within Academic Medicine. Acad Med. 2021;96(6):813-816. doi:10.1097/ACM.0000000000003782

    Association of American Medical Colleges. U.S. Medical School Faculty, 2017 (Table C: Department Chairs by Department, Sex, and Race/Ethnicity, 2017). https://www.aamc.org/data-reports/faculty-institutions/interactive-data/2017-us-medical-school-faculty.

    Association of American Medical Colleges. U.S. Medical School Faculty, 2017 (Table 9: U.S. Medical School Faculty by Sex and Rank, 2017). https://www.aamc.org/data-reports/faculty-institutions/interactive-data/2017-us-medical-school-faculty.

    Coombs AA ,  King RK . Workplace discrimination: experiences of practicing physicians. J Natl Med Assoc. 2005;97:467-77. [PMID: 15868767]

    Adesoye T ,  Mangurian C ,  Choo EK ,  Girgis C ,  Sabry-Elnaggar H ,  Linos E ; Physician Moms Group Study Group. Perceived discrimination experienced by physician mothers and desired workplace changes: a cross-sectional survey. JAMA Intern Med. 2017;177:1033-6. [PMID: 28492824] doi:10.1001/jamainternmed.2017.1394

    Kitchener C. Women academics submitting fewer papers to journals during coronavirus. The Lilyhttps://www.thelily.com/women-academics-seem-to-be-submitting-fewer-papers-during-coronavirus-never-seen-anything-like-it-says-one-editor. Published April 24, 2020 Accessed April 27, 2020 [Google Scholar]8. Vincent-Lamarre P, Sugimoto C, Lariviere V. The decline of women’s research production during the coronavirus pandemic. Nature Indexhttps://www.natureindex.com/news-blog/decline-women-scientist-research-publishing-production-coronavirus-pandemic. Published May 19, 2020 Accessed May 21, 2020 [Google Scholar]

    Oliveira DFM, Ma Y, Woodruff TK, Uzzi B. Comparison of National Institutes of Health grant amounts to first-time male and female principal investigators. JAMA. 2019; 321:898–900

  • Coffee Chats,  Health

    Still think omicron is “mild”?

    Low severity of disease ≠ mild impact

    While the virulence of omicron is seemingly less severe on an individual scale and especially in those who are vaccinated, the impact of omicron on the healthcare system, schools, businesses, economy etc. has been far from mild. Notably, higher vaccination coverage during the omicron surge likely led to less severe disease for many. Yet, according to an MMWR report from the CDC, we still saw some of the highest daily case counts, hospitalizations, and emergency visits during the omicron wave. Over a 3-week period, there were more cases of omicron compared to delta and 17% higher deaths.

    The narrative that the media espoused was that omicron is a milder variant, but mild compared to what? Compared to COVID when we didn’t have vaccines available? Additionally, as the recent NY Times piece “the pandemic of the forgotten” pointed out, this narrative doesn’t take into account vulnerable populations such as the 7 million immunocompromised Americans. We do not know how well the vaccines work in this population and many of these Americans continue to live in fear for their lives while the rest of us learn to “live with the virus.” Similarly, we are neglecting to address the racial inequities and socioeconomic inequities in vaccination.

    Impact on the economy, healthcare system and schools

    According to the Census Bureau survey, 8.8 million people did not work between the end of December and the beginning of January as they had to care for themselves or someone else with COVID symptoms. In a survey of small business leaders, 71% of responders said their revenue was negatively affected due to the increase in COVID-19 cases and 37% had to close their business or scale back.

    With regard to schools, omicron caused disruptions in learning whether children were attending in person instruction or doing virtual learning. Many schools had to close temporarily and if they remained open, there were staffing shortages and child absences due to illness or quarantine, making it difficult to maintain a consistent learning environment.

    Of course, the healthcare system has been overwhelmed in a multitude of ways with 80% of hospitals are under “high or extreme stress,” record hospitalizations, extreme burnout amongst healthcare staff and staffing shortages.

    Will the next variant be less severe?

    The second narrative being pushed by the media is that the next variant will be even less severe. There is no certainty that this will be the case. Even if it is the case, less severe cases of COVID can still cause long COVID. Data also shows that even a less severe case of COVID-19 can increase a person’s risk of cardiovascular problems for at least a year after diagnosis. The rates of conditions such as heart failure and stroke are much higher in people who have recovered from COVID-19 than in those who never had COVID-19.

    What comes next?

    Well that depends on our level of preparedness. With less than two-thirds of Americans fully vaccinated and only one-fourth of Americans having received a booster shot, we still have a long way to go in our vaccination efforts. Recent data shows that a third dose of the mRNA vaccines was highly effective at preventing Covid-19 associated emergency room and urgent care visits by 94% during the Delta wave and 82% during the omicron wave. The risk of hospitalization was also decreased by 94% for Delta and 90% for omicron after a third shot.

    Additionally, as I’ve mentioned before, masking is a low cost, effective tool and sadly, it is being politicized. While I don’t think we will need to mask forever, we have still not vaccinated a large enough percentage of the population, only 24% of children ages 5-11 are vaccinated and children under 5 cannot be vaccinated so masking is still essential.

    I also just want to remind everyone that the goal was never to eradicate COVID (although that would be nice), the goal was to mitigate its effects on our health, hospital systems, schools and our economy. Vaccination is effective in preventing deaths, reducing hospitalizations and reducing the severity of disease. The next time someone describes omicron as mild, it needs to be taken into context that vaccination has allowed it to be viewed as mild, yet the impact on our society has not been mild whatsoever. We need to focus on increasing vaccination efforts AND promoting masking until we have successfully vaccinated a majority of our population and taken care of our most vulnerable.

    Iuliano AD, Brunkard JM, Boehmer TK, et al. Trends in Disease Severity and Health Care Utilization During the Early Omicron Variant Period Compared with Previous SARS-CoV-2 High Transmission Periods — United States, December 2020–January 2022. MMWR Morb Mortal Wkly Rep 2022;71:146–152. DOI: http://dx.doi.org/10.15585/mmwr.mm7104e4external icon.

    https://www.census.gov/data/tables/2021/demo/hhp/hhp41.html

    https://www.goldmansachs.com/citizenship/10000-small-businesses/US/infographics/small-businesses-on-the-brink/index.html

    https://www.edweek.org/teaching-learning/omicron-is-making-a-mess-of-instruction-even-where-schools-are-open/2022/01

    https://www.theguardian.com/society/2022/feb/03/us-coronavirus-healthcare-system-providers

    Anindit Chhibber, Aditi Kharat, Khanh Duong, Richard E. Nelson, Matthew H. Samore, Fernando A. Wilson, Nathorn Chaiyakunapruk,Strategies to minimize inequity in COVID-19 vaccine access in the US: Implications for future vaccine rollouts, The Lancet Regional Health – Americas, Volume 7, 2022, 100138, ISSN 2667-193X, https://doi.org/10.1016/j.lana.2021.100138.
    (https://www.sciencedirect.com/science/article/pii/S2667193X21001344)

    https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html

    https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e3.htm

    COVID Symptoms, Symptom Clusters, and Predictors for Becoming a Long-Hauler: Looking for Clarity in the Haze of the PandemicYong Huang, Melissa D. Pinto, Jessica L. Borelli, Milad Asgari Mehrabadi, Heather Abrihim, Nikil Dutt, Natalie Lambert, Erika L. Nurmi, Rana Chakraborty, Amir M. Rahmani, Charles A. DownsmedRxiv 2021.03.03.21252086; doi: https://doi.org/10.1101/2021.03.03.21252086

    Xie, Y., Xu, E., Bowe, B. & Al-Aly, Z. Nature Med. https://www.nature.com/articles/s41591-022-01689-3 (2022).

     Johnson AG, Amin AB, Ali AR, et al. COVID-19 Incidence and Death Rates Among Unvaccinated and Fully Vaccinated Adults with and Without Booster Doses During Periods of Delta and Omicron Variant Emergence — 25 U.S. Jurisdictions, April 4–December 25, 2021. MMWR Morb Mortal Wkly Rep 2022;71:132–138. DOI: http://dx.doi.org/10.15585/mmwr.mm7104e2