Giving Thanks (and Christmas Decorating)

I hear there's snow in Baltimore. Here's what it looks like today in KL:

View from our balcony looking down to the pool

First, please let me apologize for the delayed posting! Work's been keeping me busy, but I can't punt this one to Brian because he's away on a medical relief mission in the Philippines. Our friend and Brian's colleague, Nicole, has worked for many years with an Operation Smile team out of the Philippines. While they usually travel to remote areas to operate on children with cleft lips and cleft palates, in times of disasters - such as the aftermath of Hurricane Haiyan (Yolanda) - the team transforms into a mobile med-surg unit. In collaboration with the Philippines Red Cross, a team from Brian's work here at PUGSOM (4 Hopkins docs, plus several students) headed over last week to staff a hospital in Ormoc, an area badly hit by the storm that as of yet has received little assistance. That's about all I know -- communication is limited. The brief message I've received (one one-line text) says that it's hot and they are "extremely busy, but good." Say tuned for Brian's account of his experiences in our next posts. (And forgive all the typos in this post. Brian usually proof reads for me!)  

Anyway, let me catch you up on the adventures of the last two weeks...

The end of November brought wonderful Thanksgiving and Hanukkah celebrations! It was a bit odd to celebrate Thanksgiving (and Hanukkah with the Miller/Wiener's) when no one else is celebrating. In the US for Thanksgiving, work stops for 4 (or 5 or 6) days. Here, the kids were in school on Thanksgiving day and the day after and everyone was working. Robin and I made an executive decision to hold the Thanksgiving celebration on Friday. That way everyone could make it to the party after work and we'd not need to worry about getting the kids to bed.

Robin and Ethan offered to host. It was most certainly Thanksgiving, Malaysia style. We enjoyed all the traditional Thanksgiving foods--turkey, stuffing, cranberries, mashed potatoes, pumpkin pie. But we had a few new ones, too. Turkey is so crazy expensive, that we decided to complement our small turkey with a few extra birds--namely Chinese style crispy ducks. We invited to the celebration all the faculty from Brian's work; some are from the US, others are in KL from across the world. So new favorites to the Thanksgiving menu were homemade palak paneer, butter chicken, and Abhi's lychee martinis. (Note to the Pohl family: We may have to adopt Abhi--he rolled up to Thanksgiving dinner with a mobile bar, complete with blender, shaker, and martini glasses.)

Robin and Ethan's neighborhood indoor/outdoor space was ideal for Malaysian Thanksgiving. The kids swam in the pool all night. There were no American football games played (nor watch on TV) and no turkey trot. Still, at the end of the celebration I had that wonderful warm feeling of bring surrounded by people I love being with, plus a very full belly, and a calmness after the chaos of a great event! Hugs and kisses to Robin and Ethan for hosting.

You have no idea how happy I was to find this...

...Or what a pain it was to cook  4 pies and two casseroles in our (toaster) oven.

Last week, I had a wonderful work-related surprise. It was a huge honor to be invited to participate in an international Joint Learning Network conference titled "Demystifying DRGs" here in KL. The small world just got smaller. The Joint Learning Network is a collection of low- and middle-income nations that form a learning collaborative around issues of universal health care coverage. Health officials from Malaysia, Vietnam, the Philippines, Indonesia, Ghana, India, and Nigeria exchanged practical ideas and advice about hospital payment reform. I participated on two panels, one on the selection of a grouper and the other on post-DRG implementation issues. (Big shout out to Patrick Redmon who returned my Thanskgiving weekend call to share Maryland's experience when moving to APR-DRGs.) In moving to Malaysia, I didn't have any clue that my Medicaid (uniquely American) and HSCRC (uniquely Maryland) experiences could transfer to international work. Maybe I had preconceived ideas of how health finance works abroad. Or actually, I think it was more naivety. Either way, I learned at the conference that these nations' health officials face many similar challenges as we do as government officials Maryland. We're all dealing with big picture financing questions: reimbursement for volume vs quality, allocation of resources. We also deal with all the nitty-gritty logistic things, too, like how to allocate expenses across rate centers in a top down accounting system and how to establish and apply equivalent inpatient admissions to outpatient settings. I very much hope to continue to engage with the Malaysian Ministry of Health team and other countries in the Joint Learning Network. Thank you, Amanda Folsom for connecting me to the JLN team!

Speaking of health (with no HIPAA privacy laws broken) - my friend here needed an MRI of her back. We walked into a private hospital 10 minutes after getting the appointment, got the MRI in a state of the art GE machine, had them slap the images on a DVD, and walked out after paying the bill in cash: $350.00 (US dollars). Anyone want to guess the cost of that transaction in the US? And yes, that INCLUDED the fee for the radiologist read, emailed to my friend a few hours later.

The Miller Wieners came over to our place to celebrate the seventh night of Hanukkah.
(They brought the menorah.)

Last week the kids' school held their annual "Mufti Day". I received 15 emails from the school about this, sent in a bunch of requested money, signed two permission slips -- all still without having a clue what Muft Day was. I Googled "Mufti Day". It means casual Friday or dress down day. Not helpful. Finally I went to Tyler's teacher and just asked straight out - what is this thing? In her most lovely British accent she explained that it is a day in which the kids blow off school, dress up, and have fun. This means a fair with games, candy, bounce houses, etc. For the lower primary, the Year 6 kids (5th graders) staged a carnival. They created games and made prizes. (Think: shoot the nerf gun at the cans, throw a soaked sponge at a girl who tries to dodge, shoot the nurf gun at the cards, kick a ball in a mini soccer goal, shoot the nurf gun at the car.) It was cute(ish). The kids had a blast and collected a huge bag of candy.

While Brian was away this weekend, the kids and I got in the holiday spirit. We asked ourselves, why do we decorate pine trees for the holidays? I'm not talking historically, I'm talking logistically. Why not a maple tree or elm tree... Well, we decided it's because all those others aren't green in the winter. So here in Malaysia, all our trees are ever green year round. So in my mind, there was no need to buy a million dollar imported pine tree. Instead, the kids and I dragged the palm tree in from the balcony and set to work making and hanging origami ornaments. Telling this to my mom gave her a good laugh. When I was a small child, my family lived in Japan and my mom decorated our Christmas tree in origami cranes. The cranes were so hated by my three-year-old self that I smashed them. All of them. Full circle, I guess, as I'm living in Asia and folding paper for our own tree. Except my kids have totally bought into the palm tree idea and love their origami. Maybe all those years I've work on stakeholder engagement are not wasted. We brought along only a few other Christmas things. The stockings are hand made by our family friend, the nativity scene, and a bunch of Spode dishes.

Let me run now. Kids are finishing swim lessons - Violet just learned the butterfly. I see visions of hot milo in our future. Maybe we will watch Elf because "I just like to smile, smiling's my favorite."

And just in case you were worried that we don't have enough Christmas cheer in Malaysia, check out the decorations at the mall!